Topical anti-inflammatory medications are becoming routine treatment for patients with osteoarthritis. These offer localized pain relief for patients and do not carry the same potential risk for adverse events as seen with oral non-steroidal anti-inflammatory drugs (NSAIDs). As with most other topical agents, these medications are significantly more expensive than oral medications due to the nature of the production complications associated with emulsion of an active ingredient in a delivery vehicle of either a suspension or a gel. In the topical diclofenac products category, there are several different options for patients. Clinically, there is no significant difference in the efficacy of these products and reduction of WOMAC sores (Western Ontario and McMaster Universities Osteoarthritis Index), but the cost can vary substantially from one product to another. It is important to recognize this cost difference as utilizing the lower cost drugs results in lowering of overall cost of care, which is directly related to the shared savings under value-based contracts. When selecting a topical diclofenac preparation, patients should be prescribed the therapy in a stepwise approach, starting with the 1.0% formulation followed by observation of how the patient responds to therapy before moving on to higher strength. If patients have localized pain, they should first be prescribed traditional NSAIDs, unless they have failed them in the past or have a specific contraindication to them.
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