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Cost-effectiveness of duloxetine for knee OA subjects: the role of pain severity
- Source :
- Osteoarthritis Cartilage
- Publication Year :
- 2020
-
Abstract
- OBJECTIVE: Establish the impact of pain severity on the cost-effectiveness of generic duloxetine for knee osteoarthritis (OA) in the United States. DESIGN: We used a validated computer simulation of knee OA to compare usual care (UC) – intra-articular injections, opioids, and total knee replacement (TKR) - to UC preceded by duloxetine in those no longer achieving pain relief from non-steroidal anti-inflammatory drugs (NSAIDs). Outcomes included quality-adjusted life years (QALYs), lifetime medical costs, and incremental cost-effectiveness ratios (ICERs). We considered cohorts with mean ages 57–75 years and Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain 25–55 (0–100, 100-worst). We derived inputs from published data. We discounted costs and benefits 3% annually. We conducted sensitivity analyses of duloxetine efficacy, duration of pain relief, toxicity, and costs. RESULTS: Among younger subjects with severe pain (WOMAC pain=55), duloxetine led to an additional 9.6 QALYs per 1000 subjects (ICER=$88,500/QALY). The likelihood of duloxetine being cost-effective at willingness-to-pay (WTP) thresholds of $50,000/QALY and $100,000/QALY was 40% and 54%. Offering duloxetine to older patients with severe pain led to ICERs >$150,000/QALY. Offering duloxetine to subjects with moderate pain (pain=25) led to ICERs $88,500/QALY.
- Subjects :
- 0301 basic medicine
musculoskeletal diseases
medicine.medical_specialty
WOMAC
Cost effectiveness
Cost-Benefit Analysis
Total knee replacement
Biomedical Engineering
Pain relief
Osteoarthritis
Duloxetine Hydrochloride
Article
Injections, Intra-Articular
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Rheumatology
medicine
Duloxetine
Humans
Orthopedics and Sports Medicine
Computer Simulation
Arthroplasty, Replacement, Knee
Glucocorticoids
health care economics and organizations
Aged
Pain Measurement
030203 arthritis & rheumatology
Analgesics
business.industry
Middle Aged
Osteoarthritis, Knee
medicine.disease
humanities
Analgesics, Opioid
030104 developmental biology
chemistry
Pain severity
Physical therapy
Quality-Adjusted Life Years
business
Medical costs
Subjects
Details
- ISSN :
- 15229653
- Volume :
- 29
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Osteoarthritis and cartilage
- Accession number :
- edsair.doi.dedup.....07bdf74bf4b014088b6c72dec22f6a3b