Value of Information in the Osteoarthritis Setting
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Background: Recent National Institute for Health and Clinical Excellence (NICE) guidance recommended that when traditional NSAIDs or cyclooxygenase (COX)-2 selective inhibitors are used by people with osteoarthritis (OA), they should be prescribed along with a proton pump inhibitor (PPI). However, specific recommendations about the type ofNSAID orCOX-2 could not be made due to high levels of uncertainty in the economic evaluation.
Objective: To investigate the value of obtaining further evidence to inform the economic evaluation of NSAIDs, COX-2s and PPIs for people with OA.
Methods: An economic evaluation with an expected value of perfect information (EVPI) analysis was conducted, using a Markov model with data identified from a systematic review. The base-case model used adverse event data from the three largest randomized trials of COX-2 inhibitors, and we repeated the analysis using observational adverse event data. The model was run for a hypothetical population of people with OA, and subgroup analyses were conducted for people with raised gastrointestinal (GI) and cardiovascular (CV) risk. The EVPI was based upon the OA population in England — approximately 2.8 million people. Of these, 50% were assumed to use NSAIDs or COX-2 selective inhibitors for 3 months per year and 56% of these were assumed to be patients with raised GI and CV risk.
Results: The value of further information for this decision problem was very high. Population-level EVPI was £85.1 million in the low-risk group and £179.5 million in the high-risk group (2007–8 values). Expected value of partial perfect information (EVPPI) analysis showed that the groups of parameters for which further evidence was likely to be of most value were CV adverse event risks and all adverse event rates associated with the specific drugs celecoxib and ibuprofen. The value of perfect information remained high even when observational adverse event data were used.
Conclusions: There is a very high value associated with obtaining further information on uncertain parameters for the economic evaluation of NSAIDs, COX-2 selective inhibitors and PPIs for people with OA. Obtaining further randomized or observational information on CV risks is likely to be particularly cost effective.
KeywordsCelecoxib Proton Pump Inhibitor Utility Score Etoricoxib Adverse Event Data
The authors gratefully acknowledge the advice and input of other members of the Osteoarthritis Guideline Development Group and other experts who advised the group regarding the original economic model: Dr Fraser Birrell, Dr Michael Burke, Ms Jo Cumming, Professor Paul Dieppe, Professor Mike Doherty, Dr Krysia Dziedzic, Professor Roger Francis, Mrs Christine Kell, Professor Alex MacGregor, Ms Carolyn Naisby, Mrs Susan Oliver, Mrs Alison Richards, Dr Martin Underwood, Dr Garry Barton, Dr Bernard Higgins.
All authors were members of the Guideline Development Group (PGC chaired the Group, JD was the clinical advisor, RLG was NCC-CC project manager, NL was the NCC-CC health economist, JL was the NICE technical advisor and RO was the NCC-CC research fellow). During the guidelines process, PGC received travel grants to educational meetings from Merck Sharp & Dohme (MSD), honoraria for joint injection tutorials (MSD) and has been advisor to Novartis and Bristol Myers Squibb on imaging studies in rheumatoid arthritis. JD has received travel grants from Pfizer, Wyeth, Novartis and Napp, and honoraria for tutorials from Pfizer and Novartis; he has been on advisory boards for pharmaceutical companies, including GSK, Wyeth and Novartis. After completing the guideline analysis but prior to its publication, NL joined Roche Products Ltd and has since moved to the University of Sheffield. RLG, JL and RO have no competing interests.
The NCC-CC was commissioned and funded by NICE to complete the Osteoarthritis Clinical Guideline; however, this supplementary analysis was undertaken subsequent to the guideline process and no further funding was received.
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