title: Disease-modifying drugs for knee osteoarthritis: can they be cost-effective?
abstract: 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.
  
  
  METHODS
  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.
authors: Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA. elosina@partners.org
authors: E
authors: E
authors: Losina
authors: M E
authors: ME
authors: Daigle
authors: L G
authors: LG
authors: Suter
authors: D J
authors: DJ
authors: Hunter
authors: D H
authors: DH
authors: Solomon
authors: R P
authors: RP
authors: Walensky
authors: J M
authors: JM
authors: Jordan
authors: S A
authors: SA
authors: Burbine
authors: A D
authors: AD
authors: Paltiel
authors: J N
authors: JN
authors: Katz
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D020370:Osteoarthritis, Knee / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D011788:Quality of Life; D012680:Sensitivity and Specificity; D014481:United States
chemical_list: D000893:Anti-Inflammatory Agents
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