期刊
OSTEOARTHRITIS AND CARTILAGE
卷 21, 期 5, 页码 655-667出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.joca.2013.01.016
关键词
Knee osteoarthritis; Cost-effectiveness; Quality of life; Disease-modifying osteoarthritis drugs (DMOADs)
资金
- NIH/NIAMS [R01 AR053112, K24 AR057827]
- VA Connecticut Healthcare System
- Centers for Medicare 82 Medicaid Services, an Agency of the U.S. Department of Health and Human Services [HHSM-500-2008-0025I/HHSM-500-T0001]
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. (C) 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
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