Cost-effectiveness of treatment strategies for osteoarthritis of the knee in Taiwan.
OBJECTIVE
To evaluate the cost-effectiveness of 3 treatment strategies for osteoarthritis (OA) of the knee: naproxen, celecoxib, and hyaluronan.


METHODS
We developed a decision model to estimate the costs and effectiveness of 3 treatment strategies: 250 mg naproxen 3 times daily for 26 weeks, 100 mg celecoxib twice daily for 26 weeks, and 25 mg hyaluronan by intraarticular injection once per week for 5 weeks followed by conventional treatment for 21 weeks. The probabilities and utility data were obtained by surveying the literature and consulting experts. Cost data were obtained from insurance reimbursement data of National Taiwan University Hospital and were converted to 2002 US dollars. The timeframe of the decision tree was 26 weeks. Outcomes were expressed in aggregated costs, quality-adjusted life-years (QALY), and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed on most variables.


RESULTS
The expected total costs for the naproxen, celecoxib, and hyaluronan strategies were US$498.98, US$547.80, and US$678.00, respectively. The ICER of the celecoxib strategy compared with the naproxen strategy was US$21,226 per QALY gained. The ICER of the hyaluronan strategy versus the celecoxib strategy was US$42,000 per QALY gained. The ICER of the hyaluronan strategy decreased to about US$25,000 per QALY gained if the weekly treatment cost of hyaluronan was decreased to US$31.


CONCLUSIONS
Celecoxib treatment results in a reasonable cost-effectiveness ratio for patients with OA of the knee. Hyaluronan treatment, however, may not be an economically attractive choice under the current healthcare scenario in Taiwan.
Yen
Zui-Shen
ZS
Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan.
Lai
Mei-Shu
MS
Wang
Chen-Ti
CT
Chen
Li-Shu
LS
Chen
Shyr-Chyr
SC
Chen
Wen-Jone
WJ
Hou
Sheng-Mou
SM
D000276:Adjuvants, Immunologic / Q000191:economics / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics* / Q000627:therapeutic use; D000068579:Celecoxib; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000191:economics / Q000627:therapeutic use; D008875:Middle Aged; D009288:Naproxen / Q000191:economics* / Q000627:therapeutic use; D020370:Osteoarthritis, Knee / Q000188:drug therapy* / Q000191:economics*; D011720:Pyrazoles; D012680:Sensitivity and Specificity; D013449:Sulfonamides / Q000191:economics / Q000627:therapeutic use; D013624:Taiwan
D000276:Adjuvants, Immunologic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D011720:Pyrazoles; D013449:Sulfonamides; D009288:Naproxen; D006820:Hyaluronic Acid; D000068579:Celecoxib