|Title:||Disease-modifying drugs for knee osteoarthritis: can they be cost-effective?|
Daigle, Meghan E.
Reichmann, William M.
Suter, Lisa G.
Hunter, David J.
Solomon, Daniel H.
Walensky, Rochelle P.
Jordan, Joanne M.
Burbine, Sara A.
Patiel, A. Daniel
Katz, Jeffrey N.
|Citation:||Disease-modifying drugs for knee osteoarthritis: can they be cost-effective?, Osteoarthritis and Cartilage, vol.21, 5, 2013,pp 655-667|
|Abstract:||OBJECTIVE: Disease-modifying osteoarthritis drugs (DMOADs) are under development. Our goal was to determine efficacy, toxicity, and cost thresholds under which DMOADs would be a cost-effective knee OA treatment. DESIGN: We used the Osteoarthritis Policy Model, a validated computer simulation of knee OA, to compare guideline-concordant care to strategies that insert DMOADs into the care sequence. The guideline-concordant care sequence included conservative pain management, corticosteroid injections, total knee replacement (TKR), and revision TKR. Base case DMOAD characteristics included: 50% chance of suspending progression in the first year (resumption rate of 10% thereafter) and 30% pain relief among those with suspended progression; 0.5%/year risk of major toxicity; and costs of $1,000/year. In sensitivity analyses, we varied suspended progression (20-100%), pain relief (10-100%), major toxicity (0.1-2%), and cost ($1,000-$7,000). Outcomes included costs, quality-adjusted life expectancy, incremental cost-effectiveness ratios (ICERs), and TKR utilization. RESULTS: Base case DMOADs added 4.00 quality-adjusted life years (QALYs) and $230,000 per 100 persons, with an ICER of $57,500/QALY. DMOADs reduced need for TKR by 15%. Cost-effectiveness was most sensitive to likelihoods of suspended progression and pain relief. DMOADs costing $3,000/year achieved ICERs below $100,000/QALY if the likelihoods of suspended progression and pain relief were 20% and 70%. At a cost of $5,000, these ICERs were attained if the likelihoods of suspended progression and pain relief were both 60%. CONCLUSIONS: Cost, suspended progression, and pain relief are key drivers of value for DMOADs. Plausible combinations of these factors could reduce need for TKR and satisfy commonly cited cost-effectiveness criteria|
|Type of Work:||Article|
|Type of Publication:||Post-print|
|Appears in Collections:||Research Papers and Publications. NCS Medicine|
|2.pdf||550.19 kB||Adobe PDF|
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