Pharmacologic regimens for knee osteoarthritis prevention: can they be cost-effective?

• Published in: Osteoarthritis and cartilage Vol. 22; no. 3; pp. 415 - 430
• Main Authors: Losina, E, Burbine, S.A, Suter, L.G, Hunter, D.J, Solomon, D.H, Daigle, M.E, Dervan, E.E, Jordan, J.M, Katz, J.N
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-03-2014
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Computer Simulation; Cost-Benefit Analysis; Cost-effectiveness; Disease-modifying osteoarthritis drugs; Female; Humans; Knee Injuries - epidemiology; Knee osteoarthritis; Male; Middle Aged; Obesity - epidemiology; Osteoarthritis, Knee - economics; Osteoarthritis, Knee - epidemiology; Osteoarthritis, Knee - prevention & control; Prophylaxis; Quality-Adjusted Life Years; Rheumatology; Risk Factors; Treatment Outcome; Disease-modifying osteoarthritis drugs; Knee osteoarthritis; Cost-effectiveness; Prophylaxis
• ISSN: 1063-4584; 1522-9653
• DOI: 10.1016/j.joca.2014.01.005

Summary Objective We sought to determine the target populations and drug efficacy, toxicity, cost, and initiation age thresholds under which a pharmacologic regimen for knee osteoarthritis (OA) prevention could be cost-effective. Design We used the Osteoarthritis Policy (OAPol) Model, a validated state-transition simulation model of knee OA, to evaluate the cost-effectiveness of using disease-modifying OA drugs (DMOADs) as prophylaxis for the disease. We assessed four cohorts at varying risk for developing OA: (1) no risk factors, (2) obese, (3) history of knee injury, and (4) high-risk (obese with history of knee injury). The base case DMOAD was initiated at age 50 with 40% efficacy in the first year, 5% failure per subsequent year, 0.22% major toxicity, and annual cost of $1,000. Outcomes included costs, quality-adjusted life expectancy (QALE), and incremental cost-effectiveness ratios (ICERs). Key parameters were varied in sensitivity analyses. Results For the high-risk cohort, base case prophylaxis increased quality-adjusted life-years (QALYs) by 0.04 and lifetime costs by $4,600, and produced an ICER of $118,000 per QALY gained. ICERs >$150,000/QALY were observed when comparing the base case DMOAD to the standard of care in the knee injury only cohort; for the obese only and no risk factors cohorts, the base case DMOAD was less cost-effective than the standard of care. Regimens priced at $3,000 per year and higher demonstrated ICERs above cost-effectiveness thresholds consistent with current US standards. Conclusions The cost-effectiveness of DMOADs for OA prevention for persons at high risk for incident OA may be comparable to other accepted preventive therapies.