Cost‐Effectiveness of Tramadol and Oxycodone in the Treatment of Knee Osteoarthritis

Smith, Savannah; Katz, Jeffrey N.; Collins, Jamie E.; Solomon, Daniel H.; Jordan, Joanne M.; Suter, Lisa G.; Yelin, Edward H.; Paltiel, A. David; Losina, Elena

doi:10.1002/acr.22916

Cited by 33 publications

(46 citation statements)

References 35 publications

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“…Moreover CPM may respond to rehabilitation, such as the joint mobilization intervention evaluated in our previous study . Such nonpharmacological interventions can be important additions to our treatment arsenal given the risks, and in some cases, the limited benefit, of commonly used medications or medication classes (e.g., NSAIDS and opioids) . Future studies are needed to expand on these findings and determine whether CPM assessment and treatment can have a role in identifying appropriate surgical candidates, timing surgical interventions or optimizing patients before TKA.…”

Section: Discussionmentioning

confidence: 89%

“…13 Such nonpharmacological interventions can be important additions to our treatment arsenal given the risks, and in some cases, the limited benefit, of commonly used medications or medication classes (e.g., NSAIDS and opioids). [48][49][50] Future studies are needed to expand on these findings and determine whether CPM assessment and treatment can have a role in identifying appropriate surgical candidates, timing surgical interventions or optimizing patients before TKA. A better understanding of disease chronicity and any role of sex differences in pain processing can help lead to more effective interventions for knee OA, and reduce the sex and gender disparities reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

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Duration of symptoms is associated with conditioned pain modulation and somatosensory measures in knee osteoarthritis

Foucher

Chmell

Courtney

2018

Journal Orthopaedic Research

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Impaired descending pain inhibition has been linked to chronic pain and poorer patient outcomes. Vibration perception threshold (VPT) has also been observed and linked to radiographic stage of OA. However, it is not known how duration of symptoms may influence these neurophysiological measures. Our purpose was to evaluate the relationship between duration of symptoms and conditioned pain modulation (CPM), a measure of descending pain inhibition, and VPT, and to determine whether these relationships differed in men and women seeking orthopedic care. We evaluated 18 men and 27 women with moderate to severe knee OA. We assessed CPM using a submaximal‐effort tourniquet test: Pressure pain threshold (PPT) at the symptomatic knee was evaluated before and after a noxious stimulus. CPM impairment was indicated by a ratio of pre‐to‐post stimulus PPT ≥1. VPT was assessed using a biothesiometer at the medial femoral condyle. We used chi‐square, t‐tests and Pearson correlations to address study questions. 72% of men, but only 44% of women had CPM impairment. Duration of symptoms was associated with CPM impairment in women (R = 0.566, p = 0.003) but not men (R = 0.366, p = 0.135). Duration of symptoms was also associated with VPT in both men (R = 0.580, p = 0.012) and women (R = 0.406, p = 0.039). These results suggest that longer duration of knee OA may predict more severe pain sensitization and that important sex differences exist in descending pain inhibition in people with chronic knee OA that may affect disease and course of treatment in male and female patients. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Duration of symptoms is associated with conditioned pain modulation and somatosensory measures in knee osteoarthritis

Foucher

Chmell

Courtney

2018

Journal Orthopaedic Research

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“…From a societal perspective, widespread use of opioids in OA has the potential to have a significant impact on the numbers of opioids in circulation, given the substantial and growing population prevalence of OA . From an OA surgical treatment perspective, it is also of concern given mounting evidence that suggests that presurgical opioid use may negatively impact surgical outcomes leading to less improvement in pain and function, greater postsurgical opioid use, and higher rates of adverse events .…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Opioid Use in Presurgical Knee, Hip, and Spine Osteoarthritis Patients

Power

Perruccio

Gandhi

et al. 2019

Arthritis Care & Research

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Objective. To evaluate rates of prescription opioid use among patients with presurgical knee, hip, and spine osteoarthritis (OA) and associations between use and sociodemographic and health status characteristics.Methods. Participants were patients with presurgical, end-stage OA of the knee (n = 77), hip (n = 459), and spine (n = 168). Data were collected on current use of opioids and other pain medications, as well as measures of sociodemographic and health status variables and depression and pain (0-10 numeric rating scale). Rates of opioid use were calculated by sex, age, and surgical site. Multivariable logistic regression was used to examine associations between opioid use (sometimes/daily versus never) and other study variables.Results. The mean age of participants was 65.6 years; 55.5% were women, 15% of patients reported "sometimes" using opioids, and 15% reported "daily use." Use of opioids was highest among patients with spine OA (40%) and similar among patients with knee and hip OA (28% and 30%, respectively). Younger women (ages <65 years) reported the greatest use of opioids overall, particularly among patients with spine OA. From multivariable logistic regression, greater likelihood of opioid use was significantly associated with spine OA (versus knee OA), obesity, being a current or former smoker, higher symptomatic joint count, greater depressive symptoms, greater pain, and current use of other prescription pain medication.Conclusion. Nearly one-third of patients with presurgical OA used prescription opioid medication. Given the questionable efficacy of opioids in OA and risk of adverse effects, higher opioid use among younger individuals and those with depressive symptoms is of concern and warrants further investigation.

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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 Tramadol and Oxycodone in the Treatment of Knee Osteoarthritis

Cited by 33 publications

References 35 publications

Duration of symptoms is associated with conditioned pain modulation and somatosensory measures in knee osteoarthritis

Duration of symptoms is associated with conditioned pain modulation and somatosensory measures in knee osteoarthritis

Factors Associated With Opioid Use in Presurgical Knee, Hip, and Spine Osteoarthritis Patients

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

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