Cost Effectiveness of Pharmacological Management for Osteoarthritis: A Systematic Review

• Published in: Applied health economics and health policy 2022-05, Vol.20 (3), p.351-370
• Main Authors: Shi, Jiayu, Fan, Kenan, Yan, Lei, Fan, Zijuan, Li, Fei, Wang, Guishan, Liu, Haifeng, Liu, Peidong, Yu, Hongmei, Li, Jiao Jiao, Wang, Bin
• Format: Article
• Language: English
• Subjects: Analgesics; Anti-inflammatory agents; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Arthritis; Bias; Chronic illnesses; Content analysis; Continents; Cost analysis; Cost-Benefit Analysis; Diabetes; Drugs; Economics; Effectiveness; Health Administration; Health care expenditures; Health Economics; Health services; Health technology assessment; Heterogeneity; Humans; Management; Medicine; Medicine & Public Health; Methodological approaches; Morbidity; Narcotics; Nonsteroidal anti-inflammatory drugs; Opioids; Osteoarthritis; Osteoarthritis - drug therapy; Patients; Pharmacoeconomics and Health Outcomes; Population; Productivity; Public Health; Quality of life; Quality of Life Research; Quality-Adjusted Life Years; Search strategies; Standardization; State Medicine; Systematic Review; Technology assessment
• ISSN: 1175-5652; 1179-1896
• DOI: 10.1007/s40258-022-00717-0

Background and objective Osteoarthritis (OA) is a highly prevalent, disabling disease requiring chronic management that is associated with an enormous individual and societal burden. This systematic review provides a global cost-effectiveness evaluation of pharmacological therapy for the management of OA. Methods Following Center for Reviews and Dissemination (CRD) guidance, a literature search strategy was undertaken using PubMed, EMBASE, Cochrane Library, Health Technology Assessment (HTA) database, and National Health Service Economic Evaluation database (NHS EED) to identify original articles containing cost-effectiveness evaluation of OA pharmacological treatment published before 4 November 2021. Risk of bias was assessed by two independent reviewers using the Joanna Briggs Institute (JBI) critical appraisal checklist for economic evaluations. The Quality of Health Economic Studies (QHES) instrument was used to assess the reporting quality of included articles. Results Database searches identified 43 cost-effectiveness analysis studies (CEAs) on pharmacological management of OA that were conducted in 18 countries and four continents, with one study containing multiple continents. A total of four classes of drugs were assessed, including non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, symptomatic slow-acting drugs for osteoarthritis (SYSADOAs), and intra-articular (IA) injections. The methodological approaches of these studies showed substantial heterogeneity. The incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-year (QALY) were (in 2021 US dollars) US$44.40 to US$307,013.56 for NSAIDS, US$11,984.84 to US$128,028.74 for opioids, US$10,930.17 to US$27,799.73 for SYSADOAs, and US$258.36 to US$58,447.97 for IA injections in different continents. The key drivers of cost effectiveness included medical resources, productivity, relative risks, and selected comparators. Conclusion This review showed substantial heterogeneity among studies, ranging from a finding of dominance to very high ICERs, but most studies found interventions to be cost effective based on specific ICER thresholds. Important challenges in the analysis were related to the standardization and methodological quality of studies, as well as the presentation of results.