Can we reduce disease burden from osteoarthritis?
The comparison of disparate interventions for the prevention and management of osteoarthritis (OA) is limited by the quality and quantity of published efficacy studies and the use of disparate measures for reporting clinical trial outcomes. The "transfer to utility" technique was used to translate published trial outcomes into a health-related quality-of-life (utility) scale, creating a common metric which supported comparisons between disparate interventions. Total hip replacement (THR) and total knee replacement (TKR) surgery were the most effective treatments and also highly cost-effective, at estimated cost per quality-adjusted life-year (QALY) of 7500 dollars for THR and 10000 dollars for TKR (best estimate). Other apparently highly cost-effective interventions were exercise and strength training for knee OA (< 5000 dollars/QALY), knee bracing, and use of capsaicin or glucosamine sulfate (< 10000 dollars/QALY). The cost per QALY estimates of non-specific and COX-2 inhibitor non-steroidal anti-inflammatory drugs were affected by treatment-related deaths and highly sensitive to the discounting of life-years lost. OA interventions that have been shown to be ineffective (eg, arthroscopy) are targets for redistribution of healthcare resources. OA interventions which lack efficacy studies (eg, prevention programs) require further research to assist priority setting. The application of the Health-sector Wide model to OA demonstrates its role as an evidence-based model that can be successfully applied to identify marginal interventions - those to be expanded and contracted to reduce the expected burden of disease, within current healthcare resources.
Health Economics Unit, Faculty of Business and Economics, Monash University, PO Box 477, West Heidelberg, Melbourne, VIC 3081, Australia. Leonie.Segal@buseco.monash.edu.au
Leonie
L
Segal
Susan E
SE
Day
Adam B
AB
Chapman
Richard H
RH
Osborne
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics / Q000627:therapeutic use; D001315:Australia; D001915:Braces / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine / Q000379:methods; D005081:Exercise Therapy / Q000191:economics; D006801:Humans; D008962:Models, Theoretical; D019637:Orthopedic Procedures / Q000191:economics; D010003:Osteoarthritis / Q000191:economics* / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic / Q000191:economics; D011322:Primary Prevention / Q000191:economics; D011788:Quality of Life; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal