Cost-effectiveness of nonsteroidal anti-inflammatory drugs and opioids in the treatment of knee osteoarthritis in older patients with multiple comorbidities

Summary Objective To evaluate long-term clinical and economic outcomes of naproxen, ibuprofen, celecoxib or tramadol for OA patients with cardiovascular disease (CVD) and diabetes. Design We used the Osteoarthritis Policy Model to examine treatment with these analgesics after standard of care (SOC)...

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Published in:	Osteoarthritis and cartilage 2016-03, Vol.24 (3), p.409-418
Main Authors:	Katz, J.N, Smith, S.R, Collins, J.E, Solomon, D.H, Jordan, J.M, Hunter, D.J, Suter, L.G, Yelin, E, Paltiel, A.D, Losina, E
Format:	Article
Language:	eng
Subjects:	Aged Aged, 80 and over Analgesics, Opioid - adverse effects Analgesics, Opioid - economics Analgesics, Opioid - therapeutic use Anti-Inflammatory Agents, Non-Steroidal - adverse effects Anti-Inflammatory Agents, Non-Steroidal - economics Anti-Inflammatory Agents, Non-Steroidal - therapeutic use Celecoxib - adverse effects Celecoxib - economics Celecoxib - therapeutic use Comorbidity Cost-Benefit Analysis Cost-effectiveness Drug Costs - statistics & numerical data Drug Therapy, Combination - economics Female Health Services Research - methods Humans Ibuprofen - adverse effects Ibuprofen - economics Ibuprofen - therapeutic use Male Middle Aged Naproxen - adverse effects Naproxen - economics Naproxen - therapeutic use Nonprescription Drugs - economics Nonprescription Drugs - therapeutic use Nonsteroidal anti-inflammatory drugs NSAIDS Opioids Osteoarthritis Osteoarthritis, Knee - drug therapy Osteoarthritis, Knee - economics Pain - drug therapy Pain - economics Pain Measurement - methods Proton Pump Inhibitors - economics Proton Pump Inhibitors - therapeutic use Quality-Adjusted Life Years Rheumatology Sensitivity and Specificity Tramadol - adverse effects Tramadol - economics Tramadol - therapeutic use Treatment Outcome United States
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Summary:	Summary Objective To evaluate long-term clinical and economic outcomes of naproxen, ibuprofen, celecoxib or tramadol for OA patients with cardiovascular disease (CVD) and diabetes. Design We used the Osteoarthritis Policy Model to examine treatment with these analgesics after standard of care (SOC) – acetaminophen and corticosteroid injections – failed to control pain. NSAID regimens were evaluated with and without proton pump inhibitors (PPIs). We evaluated over-the-counter (OTC) regimens where available. Estimates of treatment efficacy (pain reduction, occurring in ∼57% of patients on all regimens) and toxicity (major cardiac or gastrointestinal toxicity or fractures, risk ranging from 1.09% with celecoxib to 5.62% with tramadol) were derived from published literature. Annual costs came from Red Book Online® . Outcomes were discounted at 3%/year and included costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios (ICERs). Key input parameters were varied in sensitivity analyses. Results Adding ibuprofen to SOC was cost saving, increasing QALYs by 0.07 while decreasing cost by $800. Incorporating OTC naproxen rather than ibuprofen added 0.01 QALYs and increased costs by $300, resulting in an ICER of $54,800/QALY. Using prescription naproxen with OTC PPIs led to an ICER of $76,700/QALY, while use of prescription naproxen with prescription PPIs resulted in an ICER of $252,300/QALY. Regimens including tramadol or celecoxib cost more but added fewer QALYs and thus were dominated by several of the naproxen-containing regimens. Conclusions In patients with multiple comorbidities, naproxen- and ibuprofen-containing regimens are more effective and cost-effective in managing OA pain than opioids, celecoxib or SOC.
ISSN:	1063-4584 1522-9653