The Use of COX-1–Sparing Agents in the Federal Health System

The use of cyclooxygenase (COX-1)–sparing agents has revolutionized the treatment of rheumatic diseases. Because of the significant safety advantages of these drugs, patients at high risk for gastrointestinal (GI) side effects from using traditional nonsteroidal anti-inflammatory drugs (NSAIDs) can now achieve pain relief with a lower risk of GI adverse events. However, the costs of these drugs has placed an enormous strain on already stretched formulary budgets. The judicious use of COX-1–sparing agents has the potential to reduce the morbidity and mortality associated with NSAID therapy while saving health systems tens of millions of dollars. To allow for appropriate use of these medications in the federal health system, the author has developed an algorithm based on an analysis of the available GI safety data of the COX-1–sparing agents, the GI SCORE tool to determine GI bleeding risks, and the current cost structure of these agents.