Jean-Hugues Salmon1,2, Anne-Christine Rat3,4,5, Isabelle Charlot-Lambrecht6, Jean-Paul Eschard6, Damien Jolly7,8, Bruno Fautrel9,10. 1. Rheumatology Department, Maison Blanche Hospital, Reims University Hospitals, Reims, 51092, France. jhsalmon@chu-reims.fr. 2. Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, 51095, France. jhsalmon@chu-reims.fr. 3. Rheumatology Department, CHRU de Nancy, Hôpitaux de Brabois, Vandoeuvre-lès-Nancy, France. 4. Université de Lorraine, APEMAC, 54000, Nancy, France. 5. INSERM, CIC-EC 1433, 54000, Nancy, France. 6. Rheumatology Department, Maison Blanche Hospital, Reims University Hospitals, Reims, 51092, France. 7. Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, 51095, France. 8. Department of Research and Innovation, Robert Debré Hospital, Reims University Hospitals, 51092, Reims, France. 9. Sorbonne Université, Institut Pierre Louis de d'Epidémiologie et Santé Publique, GRC08, Paris, France. 10. Rheumatology Department, AP-HP, Pitié-Salpêtrière Hospital, 83 Boulevard de l'Hôpital, 75013, Paris, France.
Abstract
BACKGROUND: The place of disease-modifying osteoarthritis drugs (DMOADs) and intra-articular hyaluronic acid (IAHA) in the therapeutic arsenal for knee osteoarthritis (OA) remains uncertain. Indeed, these treatments have demonstrated symptomatic efficacy but no efficacy for disease modification. OBJECTIVE: This report reviews the cost effectiveness of IAHA and DMOADs used in the treatment of knee OA. METHODS: A systematic literature search of the MEDLINE, Scopus, EMBASE and Cochrane databases was performed independently by two rheumatologists who used the same predefined eligibility criteria to identify relevant articles. Papers without abstracts and in languages other than English or French were excluded. Extracted costs were annualised and converted to 2015 euros (€) using the Consumer Price Index of the relevant countries and the 2013 Purchasing Power Parities between these countries and the European Union average. RESULTS: A total of 95 abstracts were selected, and 13 articles were considered for the review: nine articles on IAHA and four on DMOADs. Only one article directly compared different IAHA compounds. Articles showed substantial heterogeneity in methodological approaches. The incremental cost-effectiveness ratios (ICERs) ranged from €4000 to €57,550 and from €240 to €53,225 per quality-adjusted life-year (QALY) gained for DMOADs and IAHA, respectively. CONCLUSIONS: This review highlights substantial heterogeneity between studies, ranging from a cost saving (or dominating) position to very high ICERs, far above the acceptability threshold of €50,000/QALY. Additional research is needed to determine reliable and robust ICER estimates for knee OA therapies.
BACKGROUND: The place of disease-modifying osteoarthritis drugs (DMOADs) and intra-articular hyaluronic acid (IAHA) in the therapeutic arsenal for knee osteoarthritis (OA) remains uncertain. Indeed, these treatments have demonstrated symptomatic efficacy but no efficacy for disease modification. OBJECTIVE: This report reviews the cost effectiveness of IAHA and DMOADs used in the treatment of knee OA. METHODS: A systematic literature search of the MEDLINE, Scopus, EMBASE and Cochrane databases was performed independently by two rheumatologists who used the same predefined eligibility criteria to identify relevant articles. Papers without abstracts and in languages other than English or French were excluded. Extracted costs were annualised and converted to 2015 euros (€) using the Consumer Price Index of the relevant countries and the 2013 Purchasing Power Parities between these countries and the European Union average. RESULTS: A total of 95 abstracts were selected, and 13 articles were considered for the review: nine articles on IAHA and four on DMOADs. Only one article directly compared different IAHA compounds. Articles showed substantial heterogeneity in methodological approaches. The incremental cost-effectiveness ratios (ICERs) ranged from €4000 to €57,550 and from €240 to €53,225 per quality-adjusted life-year (QALY) gained for DMOADs and IAHA, respectively. CONCLUSIONS: This review highlights substantial heterogeneity between studies, ranging from a cost saving (or dominating) position to very high ICERs, far above the acceptability threshold of €50,000/QALY. Additional research is needed to determine reliable and robust ICER estimates for knee OA therapies.
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