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OBJECTIVE: To evaluate, from a social security system perspective, the economic consequences of treating rheumatic diseases with nimesulide or diclofenac. DESIGN: Cost-minimisation analysis was used to estimate the incremental direct medical cost and the cost of gastrointestinal adverse events for 15 days' treatment with nimesulide compared with diclofenac. Cumulative incidence of adverse events was calculated through meta-analysis of the results of double-blind randomised clinical trials. The therapeutic pathway for ambulatory care resource use was determined by a panel of experts, and direct hospital costs were estimated from a sample of 43 patients. MAIN OUTCOME MEASURES AND RESULTS: The 15-day treatment cost with nimesulide was 35.9% lower compared with diclofenac due to the lower incidence of adverse events. Our analysis showed that nimesulide generated a cost saving of $US20.98 per patient depending on the dosage of diclofenac used.

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Rheumatology (Oxford). 1999 May;38 Suppl 1:39-46.
Economic comparison of nimesulide and diclofenac, and the incidence of adverse events in the treatment of rheumatic disease in Greece.

Liaropoulos L.

Centre for Health Services Management and Evaluation, University of Athens, Faculty of Nursing, Greece.

In Greece a 15-day treatment of rheumatic disease with diclofenac costs 56% more than treatment with nimesulide. This is due to the lower incidence of gastrointestinal adverse events with nimesulide, and the absence of serious gastrointestinal complications leading to hospitalization, which more than offset the higher acquisition cost of nimesulide. The average saving by using nimesulide instead of diclofenac is about US$21 per patient for a 15-day treatment period.

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Int J Tissue React. 1993;15(6):225-34.
Antioxidant profile of nimesulide, indomethacin and diclofenac in phosphatidylcholine liposomes (PCL) as membrane model.

Maffei Facino R, Carini M, Aldini G, Saibene L, Macciocchi A.

Istituto Chimico Farmaceutico Tossicologico, Milan, Italy.

An in vitro assay based on the oxidation of phosphatidylcholine liposomes (PCL) with which we can distinguish the anti-HO zero activity from the antilipoperoxidant (R zero, ROO zero, RO zero) has been developed for testing the free-radical-scavenging ability of antiinflammatory drugs. PCL were exposed to a flux of hydroxyl radicals generated by water sonolysis for different periods, and the spontaneous lipid peroxidative phenomenon (propagation and breakdown phases) was followed for the subsequent 24 hours. Lipid peroxidation was assayed by simultaneous measurements of a) conjugated dienes, by UV spectroscopy (absorbance and second derivative at 233 nm), b) loss of lipid substrate (PC), by HPLC, and c) breakdown products (total carbonyl functions as 2,4-dinitrophenylhydrazones). Diclofenac, nimesulide and indomethacin, added to PCL at the starting of the different stages of lipid peroxidation, were tested for their overall and specific anti-radical properties. All the drugs exhibited a remarkable scavenging activity against oxy and lipid radicals, determined as percent inhibition of the formation of conjugated dienes, at concentrations easily attainable in vivo (IC50:diclofenac 2.5 microM, nimesulide 4.92 microM, indomethacin 6.85 microM), diclofenac being the most effective in quenching the R zero and ROO degree species responsible for the propagation phase. By contrast, the antioxidant activity of nimesulide and indomethacin, less potent as alkyl and peroxyl radical scavengers, is due to their ability to restrain the induction phase of the radical chain reaction mediated by hydroxyl radicals (IC50:nimesulide 1.85 microM, indomethacin 3.57 microM).

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