Pharmacologic regimens for knee osteoarthritis prevention: can they be cost-effective?

We sought to determine the target populations and drug efficacy, toxicity, cost, and initiation age thresholds under which a pharmacologic regimen for knee osteoarthritis (OA) prevention could be cost-effective

Disease-modifying drugs for knee osteoarthritis: can they be cost-effective?

SummaryObjectiveDisease-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.DesignWe 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$1,000–$7,000). Outcomes included costs, quality-adjusted life expectancy, incremental cost-effectiveness ratios (ICERs), and TKR utilization.ResultsBase 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$3,000/year achieved ICERs below $100,000/QALY if the likelihoods of suspended progression and pain relief were 20$5,000, these ICERs were attained if the likelihoods of suspended progression and pain relief were both 60%.ConclusionsCost, 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