Disease-modifying drugs for knee osteoarthritis: can they be cost-effective?

• Published in: Osteoarthritis and cartilage Vol. 21; no. 5; pp. 655 - 667
• Main Authors: Losina, E, Daigle, M.E, Suter, L.G, Hunter, D.J, Solomon, D.H, Walensky, R.P, Jordan, J.M, Burbine, S.A, Paltiel, A.D, Katz, J.N
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-05-2013
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Anti-Inflammatory Agents - adverse effects; Anti-Inflammatory Agents - economics; Anti-Inflammatory Agents - therapeutic use; Arthroplasty, Replacement, Knee - economics; Arthroplasty, Replacement, Knee - statistics & numerical data; Cost-Benefit Analysis; Cost-effectiveness; Disease Progression; Disease-modifying osteoarthritis drugs (DMOADs); Drug Costs - statistics & numerical data; Female; Health Care Costs - statistics & numerical data; Humans; Knee osteoarthritis; Male; Middle Aged; Models, Econometric; Osteoarthritis, Knee - complications; Osteoarthritis, Knee - drug therapy; Osteoarthritis, Knee - economics; Pain - etiology; Pain - prevention & control; Quality of Life; Rheumatology; Sensitivity and Specificity; United States; United States; Knee osteoarthritis; Disease-modifying osteoarthritis drugs (DMOADs); Cost-effectiveness; Quality of life
• ISSN: 1063-4584; 1522-9653
• DOI: 10.1016/j.joca.2013.01.016

Summary 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.