Disease-modifying drugs for knee osteoarthritis: can they be cost-effective?
Disease-modifying drugs for knee osteoarthritis: can they be cost-effective?
复制标题
膝关节骨关节炎的疾病改良药物：它们能具有成本效益吗？
DOI：
10.1016/j.joca.2013.01.016
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发表时间：
2013-05
影响因子：
7
通讯作者：
Katz, J. N.
中科院分区：
文献类型：
--
作者：
Losina, E.;Daigle, M. E.;Suter, L. G.;Hunter, D. J.;Solomon, D. H.;Walensky, R. P.;Jordan, J. M.;Burbine, S. A.;Paltiel, A. D.;Katz, J. N.
关键词：
疾病缓解骨关节炎药物（DMOAD）正在开发中。我们的目标是确定疗效、毒性和成本阈值，在这些阈值下，DMOAD将是一种具有成本效益的膝关节OA治疗方法。我们使用骨关节炎政策模型，一个经过验证的计算机模拟膝关节骨性关节炎，比较指南一致的护理策略，插入DMOAD到护理序列。指南一致的护理序列包括保守性疼痛管理、皮质类固醇注射、全膝关节置换术（TKR）和翻修TKR。基础病例DMOAD特征包括：第一年暂停进展的机会为50%（此后恢复率为10%），暂停进展的患者疼痛缓解率为30%;严重毒性风险为0.5%/年;费用为1，000美元/年。在敏感性分析中，我们改变了暂停进展（20-100%），疼痛缓解（10-100%），主要毒性（0.1-2%）和成本（1,000 - 7,000美元）。结果包括成本、质量调整预期寿命、增量成本-效果比（ICER）和TKR利用率。基础情况DMOAD增加了4.00质量调整生命年（QALY）和每100人230，000美元，ICER为57，500美元/QALY。DMOAD将TKR的需求降低了15%。成本效益是最敏感的可能性暂停进展和疼痛缓解。如果进展暂停和疼痛缓解的可能性为20%和70%，则花费3，000美元/年的DMOAD实现了低于100，000美元/QALY的ICER。在5，000美元的成本下，如果暂停进展和疼痛缓解的可能性均为60%，则可以达到这些ICER。成本、暂停进展和疼痛缓解是DMOAD价值的关键驱动因素。这些因素的合理组合可以减少对TKR的需求，并满足通常引用的成本效益标准。
Disease-modifying osteoarthritis drugs (DMOADs) are under development. Our goal was to determine efficacy, toxicity, and cost thresholds under which DMOADs would be a cost-effective knee OA treatment. We used the Osteoarthritis Policy Model, a validated computer simulation of knee OA, to compare guideline-concordant care to strategies that insert DMOADs into the care sequence. The guideline-concordant care sequence included conservative pain management, corticosteroid injections, total knee replacement (TKR), and revision TKR. Base case DMOAD characteristics included: 50% chance of suspending progression in the first year (resumption rate of 10% thereafter) and 30% pain relief among those with suspended progression; 0.5%/year risk of major toxicity; and costs of $1,000/year. In sensitivity analyses, we varied suspended progression (20–100%), pain relief (10–100%), major toxicity (0.1–2%), and cost ($1,000–$7,000). Outcomes included costs, quality-adjusted life expectancy, incremental cost-effectiveness ratios (ICERs), and TKR utilization. Base case DMOADs added 4.00 quality-adjusted life years (QALYs) and $230,000 per 100 persons, with an ICER of $57,500/QALY. DMOADs reduced need for TKR by 15%. Cost-effectiveness was most sensitive to likelihoods of suspended progression and pain relief. DMOADs costing $3,000/year achieved ICERs below $100,000/QALY if the likelihoods of suspended progression and pain relief were 20% and 70%. At a cost of $5,000, these ICERs were attained if the likelihoods of suspended progression and pain relief were both 60%. Cost, suspended progression, and pain relief are key drivers of value for DMOADs. Plausible combinations of these factors could reduce need for TKR and satisfy commonly cited cost-effectiveness criteria.
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