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Cost-Effectiveness Analyses of Osteoarthritis Oral Therapies: a Systematic Review

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Abstract

Background

Cost-effectiveness analyses (CEAs) have been performed for oral non-disease-altering osteoarthritis (OA) treatments for well over a decade. During that period the methods for performing these analyses have evolved as pharmacoeconomic methods have advanced, new treatments have been introduced, and the knowledge of associated adverse events (AEs) has improved.

Objective

The objective of this systematic review was to trace the development of CEAs for oral non-disease-altering treatments in OA.

Methods

A systematic search for CEAs of OA oral treatments was performed of the English-language medical literature using the following databases: PubMed, EMBASE, MEDLINE In-Process, EconLit, and Cochrane. Key requirements for inclusion were that the population described patients with OA or arthritis and that the analysis reported at least one incremental cost-effectiveness ratio. Each identified publication was assessed for inclusion. Thirteen characteristics and all AEs appearing in each included CEA were extracted and organized. Reference lists from these CEAs were also searched. A chronology of key CEAs in the field was compiled, noting the characteristics that advanced the state of the art in modeling oral OA treatments.

Results

Thirty publications of 28 CEAs were identified and evaluated. Developments in CEAs included an expanded set of comparators that broadened from non-steroidal anti-inflammatory drugs (NSAIDs) only to NSAIDs plus gastroprotective agents, cyclooxygenase-2 inhibitors, and opioids. In turn, AEs expanded from gastrointestinal (GI) events to also include cardiovascular (CV) and neurological events. Efficacy, which initially was presumed to be equivalent for all treatments, evolved to treatment-specific efficacies. Decision-tree analyses were generally replaced by Markov models or, occasionally, stochastic or discrete event simulation. Finally, outcomes have progressed from GI-centric measures to also include quality-adjusted life-years.

Conclusion

Methods used by CEAs of oral non-disease-altering OA treatments have evolved in response to changing treatments with different safety profiles and efficacies as well as technical advances in the application of decision science to health care.

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Acknowledgments

Funding for this research was received from Eli Lilly and Company, Indianapolis, IN, USA. None of the authors have any conflicts of interest. Ankur J. Patel, an employee of Medical Decision Modeling, made substantial contributions to the work but does not meet the criteria for authorship. The article also relies on work performed by Frank Cinfio, an employee of Medical Decision Modeling.

Mr. Wielage is an employee of Medical Decision Modeling, a contracted research organization and vendor to Eli Lilly and Company. Ms. Myers is an employee of Medical Decision Modeling. Mr. Klein is an employee and principal of Medical Decision Modeling. Dr. Happich is an employee of Lilly Deutschland GmbH.

Mr. Wielage was the primary researcher, writer and compiler of this work. He is the guarantor for the overall content. Ms. Myers designed and performed the literature search. Mr. Klein edited and contributed to the conceptual framework of the manuscript. Mr. Happich initiated the project and edited the manuscript. All authors approved the final manuscript.

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  1. Medical Decision Modeling Inc., 8909 Purdue Road, Suite #550, Indianapolis, IN, 46268, USA

    Ronald C. Wielage, Julie A. Myers & Robert W. Klein

  2. Lilly Deutschland GmbH, Bad Homburg, Germany

    Michael Happich

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  1. Ronald C. Wielage
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  2. Julie A. Myers
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  3. Robert W. Klein
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  4. Michael Happich
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Correspondence to Ronald C. Wielage.

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Wielage, R.C., Myers, J.A., Klein, R.W. et al. Cost-Effectiveness Analyses of Osteoarthritis Oral Therapies: a Systematic Review. Appl Health Econ Health Policy 11, 593–618 (2013). https://doi.org/10.1007/s40258-013-0061-x

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