Economic evaluation of nimesulide versus diclofenac in the treatment of osteoarthritis in France, Italy and Spain

Objective: To assess and compare the incremental costs of the 15-day treatm ent of osteoarthritis (OA) with nimesulide vs that with diclofenac in Franc e, Italy and Spain. Design: A cost-minimisation analysis was performed through a decision tree, assuming the National Health System perspective. A meta-analysis was perfo rmed to assess the incidence of gastrointestinal adverse events (GIAEs) in patients with OA treated with nimesulide or diclofenac. Results: Three studies were included in the meta-analysis, which included a sample size of 484 patients in total. The incidence of GIAEs is higher in patients treated with diclofenac than in those treated with nimesulide. Nim esulide is cost-saving in all three countries: treatment costs are reduced by Eurodollars (EUR) 1.5 per case in France, EUR2 in Italy and EUR3.6 in Sp ain. Final results are not sensitive to variation of incidence rates of gas tric and intestinal events and to changes in the resource consumption: nime sulide always remains cost-saving. Conclusions: This is the first economic analysis carried out in three diffe rent countries on original epidemiological data comparing nimesulide and di clofenac directly. Projecting our results to the estimated OA prevalence in the entire population of the three countries, the expected savings to the NHS would vary from a minimum of EUR 17 500 000 in France to a maximum of E UR30 000 000 in Spain. It can be stated that these findings can provide sup port for clinicians and policy-makers for the adoption of this cost-saving treatment strategy in patients with OA.