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Cost-effectiveness analyses of osteoarthritis oral therapies: a systematic review.

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.

journal_name

Appl Health Econ Health Policy

journal_title

Applied health economics and health policy

authors

Wielage RC,Myers JA,Klein RW,Happich M

doi

10.1007/s40258-013-0061-x

subject

Has Abstract

pub_date

2013-12-01 00:00:00

pages

593-618

issue

eissn

1175-5652

issn

1179-1896

journal_volume

pub_type

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Cost-effectiveness analyses of osteoarthritis oral therapies: a systematic review.