Cost-effectiveness of generic celecoxib in knee osteoarthritis for average-risk patients: a model-based evaluation

Losina, Elena; Usiskin, Ilana M.; Smith, Savannah; Sullivan, James K; Smith, Karen C.; Hunter, David J.; Messier, Stephen P.; Paltiel, A. David; Katz, Jeffrey N.

doi:10.1016/j.joca.2018.02.898

Cited by 25 publications

(38 citation statements)

References 37 publications

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“…29 Cox-selective NSAIDs, on the other hand, were not cost-effective for treatment of knee OA. 29,30 Because HA injections resulted in slightly better clinical outcomes than oral NSAIDs in the current study, but likely at a higher cost, contemporary cost-effectiveness analyses that compare these 2 treatments are warranted.…”

Section: Discussionmentioning

confidence: 89%

“…38 An important consideration that was not formally assessed in this meta-analysis, yet strongly influences treatment selection, is the cost of therapy. The cost of a 6-month course of oral NSAIDs is highly variable, ranging from $130 for over-the-counter naproxen, to $440 for generic celecoxib, to $1750 for brand name celecoxib (Celebrex), 30 while a course of HA injections that is anticipated to provide 6 months of symptom relief costs approximately $1100. 41 In previous studies, cost-effectiveness appears to have been comparable with HA injections and nonselective oral NSAIDs (each approximately $15,000 per quality-adjusted life year).…”

Section: Discussionmentioning

confidence: 99%

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Hyaluronic Acid Injections or Oral Nonsteroidal Anti-inflammatory Drugs for Knee Osteoarthritis: Systematic Review and Meta-analysis of Randomized Trials

Miller

Fredericson

Altman

2020

Orthopaedic Journal of Sports Medicine

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Background: Intra-articular hyaluronic acid (HA) injections and oral nonsteroidal anti-inflammatory drugs (NSAIDs) are common treatments for symptomatic knee osteoarthritis (OA). However, the comparative effects of these treatments are unclear. Purpose: To compare the efficacy and safety of intra-articular HA injections compared with oral NSAIDs for the treatment of knee OA. Study Design: Systematic review; Level of evidence, 1. Methods: We systematically searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for randomized trials of knee OA treatment with HA injections compared with oral NSAIDs. The main outcomes were knee pain, knee function, adverse events (AEs), serious AEs, study withdrawals, and study withdrawals because of AEs. Pooled effect sizes were reported at the final follow-up with standardized mean difference (SMD) for efficacy outcomes and risk ratio (RR) for safety outcomes. Results: In 6 randomized trials of 831 patients (414 HA, 417 NSAIDs), with follow-up ranging from 5 to 26 weeks, HA injections were associated with small, statistically significant improvements in knee pain (SMD, 0.15; P = .04) and knee function (SMD, 0.23; P = .01) compared with oral NSAIDs. The risk of AEs was lower with HA compared with NSAIDs (19.8% vs 29.0%; RR, 0.74; P = .01). The risk of a serious AE (RR, 1.37; P = .71), study withdrawal (RR, 1.05; P = .68), or study withdrawal because of an AE (RR, 0.65; P = .22) was comparable between groups. Gastrointestinal concerns were the most frequent AE reported, occurring more often with NSAIDs (23.4% vs 14.1%; P = .001). AEs reported more frequently with HA injections were injection site pain (11.7% vs 4.7%; P < .001), headache (8.4% vs 4.4%; P = .03), and arthralgia (8.1% vs 2.9%; P = .001). Significant heterogeneity or publication bias was not observed for any outcome. Conclusion: Comparing short-term outcomes of HA injections with oral NSAIDs for treatment of knee OA, HA injections provided statistically significant but not clinically important improvements in knee pain and function, along with a lower overall risk of AEs.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Hyaluronic Acid Injections or Oral Nonsteroidal Anti-inflammatory Drugs for Knee Osteoarthritis: Systematic Review and Meta-analysis of Randomized Trials

Miller

Fredericson

Altman

2020

Orthopaedic Journal of Sports Medicine

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“…The popularity of Markov models increased over time from 7% (before 2008) to 88% (after 2008) (Figure 5B). There were 4 commonly used OA model structures: 1) OA policy model (a Markov model to simulate the natural history of knee OA and predominantly used in the US) (19,35,38,40–42), 2) the National Institute for Health and Care Excellence (NICE) model (a Markov model originally developed to compare NSAID/COX‐2 inhibitor oral analgesics and subsequently extended to incorporate dose titration, discontinuation, and AEs in addition to GI and cardiovascular [CV] AEs) (14,18,20,43–46), 3) a model developed by Fitzpatrick (a Markov model aimed at evaluating hip OA surgical treatments) (47–51), and 4) a decision‐tree model developed by Burke to compare NSAID/COX‐2 inhibitor oral analgesics (52–55) (see , available on the Arthritis Care & Research website at http://onlinelibrary.wiley.com/doi/10.1002/acr.24410/abstract).…”

Section: Resultsmentioning

confidence: 99%

“…The popularity of Markov models increased over time from 7% (pre-2008 period) to 88% (after 2008) (Figure 5b). There were four commonly used OA model structures : 1) OA policy (OAPoL) model (a Markov model to simulate the natural history of knee OA and predominantly used in the US) (19,35,38,(40)(41)(42); 2) the National Institute for Health and Care Excellence (NICE) model (a Markov model originally developed to compare NSAID/COX-2 inhibitor oral analgesics and subsequently extended to incorporate dose titration, discontinuation and AEs in addition to GI and cardiovascular (CV) AEs) (14,18,20,(43)(44)(45)(46);…”

Section: Model Types and Computational Softwarementioning

confidence: 99%

Systematic Review of the Evolution of Health‐Economic Evaluation Models of Osteoarthritis

Zhao

Ahmad

Graaff

et al. 2021

Arthritis Care & Research

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ObjectiveTo comprehensively synthesise the evolution of health-economic evaluation models (HEEMs) of all OA interventions including preventions, core treatments, adjunct non-pharmacological interventions, pharmacological and surgical treatments. MethodsThe literature was searched within health-economic/biomedical databases. Data extracted included: OA type, population characteristics, model setting/type/events, study perspective, comparators; and the reporting quality of the studies was assessed. The review protocol was registered at the International Prospective Register of Systematic Reviews (registration: CRD42018092937). ResultsEighty-eight studies were included. Pharmacological and surgical interventions were the focus in 51% and 44% studies, respectively. Twenty-four studies adopted a societal perspective (with increasing popularity after 2013), however most (63%) did not include indirect costs. Qualityadjusted life years (QALYs) was the most popular outcome measure since 2008. Markov models were used by 62% of studies, with increasing popularity since 2008. Until 2010, most studies used short-to-medium time horizons; subsequently a lifetime horizon became popular. Eighty-six percent of studies reported discount rate(s) (predominantly between 3% and 5%).Studies published after 2002 had a better coverage of OA-related adverse events (AEs).Reporting quality significantly improved after 2001. Conclusions 3OA HEEMs have evolved and improved substantially over time, with focus shifting from shortto-medium-term pharmacological decision-tree models to surgical-focused lifetime Markov models. Indirect costs of OA are frequently not considered, despite using a societal perspective.There was lack of reporting sensitivity of model outcome to input parameters including discount rate, OA definition, and population parameters. Whilst the coverage of OA-related AEs has improved over time, it is still not comprehensive.

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“…The D+E program was used by 0.3% of commercial plan members and 2.1% of Medicare Advantage plan members. Should payers choose to cover a D+E program, funding could come from revenues or premium increases, or funding could be reallocated from non-cost-effective programs for knee OA (eg, opioids or certain NSAIDs) (37,38). We note several limitations to this analysis.…”

Section: Discussionmentioning

confidence: 99%

Budget Impact of Funding an Intensive Diet and Exercise Program for Overweight and Obese Patients With Knee Osteoarthritis

Smith

Losina

Messier

et al. 2019

ACR Open Rheumatology

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Objective. Diet and exercise (D+E) for knee osteoarthritis (OA) is effective and cost-effective. However, costeffectiveness does not imply affordability; the impact of knee OA-specific D+E programs on insurer budgets is unknown.Methods. We estimated changes in undiscounted medical expenditures (2016 US dollars) with and without a D+E program. We accounted for both additional program outlays and potential savings from reduced use of other knee OA treatments and from reduced incidence of comorbidities. We adopted the perspective of a representative commercial insurance plan covering 200 000 individuals aged 25 to 64 years and a representative Medicare Advantage plan covering 200 000 Medicare-eligible individuals aged 65 years and older. We used the Osteoarthritis Policy Model, a validated microsimulation model of knee OA, to model D+E efficacy (measured by pain and weight reduction), adherence, and price based on the Intensive Diet and Exercise for Arthritis (IDEA) trial. In sensitivity analyses, we varied time horizon, D+E efficacy, and D+E price.Results. Over 3 years, the D+E program increased spending by $752 200 ($0.10 per member per month [PMPM]) in the commercial plan and by $6.0 million ($0.84 PMPM) in the Medicare plan. Over 3 years, the D+E program reduced opioid use by 6% and 5% and reduced total knee replacements by 5% and 4% in the commercial and Medicare plans, respectively. Expenses were higher in the Medicare plan because it had more patients with knee OA than the commercial plan.Conclusion. Although there is no established threshold to define affordability, a D+E program for knee OA would likely produce expenditures comparable with outlays for other health-promotion interventions.

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Cost-effectiveness of generic celecoxib in knee osteoarthritis for average-risk patients: a model-based evaluation

Abstract: In knee OA patients with no comorbidities, generic celecoxib is not cost-effective at its current price.

Cited by 25 publications

References 37 publications

Hyaluronic Acid Injections or Oral Nonsteroidal Anti-inflammatory Drugs for Knee Osteoarthritis: Systematic Review and Meta-analysis of Randomized Trials

Hyaluronic Acid Injections or Oral Nonsteroidal Anti-inflammatory Drugs for Knee Osteoarthritis: Systematic Review and Meta-analysis of Randomized Trials

Systematic Review of the Evolution of Health‐Economic Evaluation Models of Osteoarthritis

Budget Impact of Funding an Intensive Diet and Exercise Program for Overweight and Obese Patients With Knee Osteoarthritis

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