Cost-effectiveness of duloxetine for knee OA subjects: the role of pain severity.
Cost-effectiveness of duloxetine for knee OA subjects: the role of pain severity.
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DOI：
10.1016/j.joca.2020.10.001
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发表时间：
2021-01
影响因子：
7
通讯作者：
Losina E
中科院分区：
文献类型：
--
作者：
Sullivan JK;Huizinga J;Edwards RR;Hunter DJ;Neogi T;Yelin E;Katz JN;Losina E
在美国，确定疼痛严重程度对通用度洛西汀治疗膝关节骨关节炎（OA）的成本-效果的影响。我们使用经验证的膝关节OA计算机模拟来比较常规护理（UC）-关节内注射，阿片类药物和全膝关节置换术（TKR）-与在非甾体抗炎药（NSAID）不再缓解疼痛的患者中使用度洛沙汀之前的UC。结果包括质量调整生命年（QER），终身医疗费用和增量成本效益比（ICER）。我们考虑的队列平均年龄为57-75岁，西安大略和麦克马斯特骨关节炎指数（WOMAC）疼痛25-55（0-100，100-最差）。我们从已发布的数据中获取输入。我们每年以3%的成本和收益贴现。我们对度洛沙汀的疗效、疼痛缓解持续时间、毒性和成本进行了敏感性分析。在重度疼痛的年轻受试者中（WOMAC疼痛=55），度洛沙汀导致每1000例受试者额外增加9.6个QALY（ICER= 88，500美元/QALY）。在50，000美元/QALY和100，000美元/QALY的支付意愿（WTP）阈值下，度洛西汀具有成本效益的可能性分别为40%和54%。向重度疼痛的老年患者提供度洛西汀导致ICER> 150，000美元/QALY。向中度疼痛（疼痛=25）受试者提供度洛西汀导致ICER <50，000美元/QALY，无论年龄如何。在不愿意或不能接受TKR的重度疼痛（疼痛=55）的膝关节OA受试者中，ICER <50，600美元/QALY，与年龄无关。对于中度疼痛或无法或不愿意接受TKR的重度疼痛受试者，度洛沙坦是膝关节OA UC的一种具有成本效益的附加治疗。在患有严重疼痛的年轻受试者中，度洛沙汀在WTP阈值> 88，500美元/QALY时具有成本效益。
Establish the impact of pain severity on the cost-effectiveness of generic duloxetine for knee osteoarthritis (OA) in the United States. We used a validated computer simulation of knee OA to compare usual care (UC) – intra-articular injections, opioids, and total knee replacement (TKR) - to UC preceded by duloxetine in those no longer achieving pain relief from non-steroidal anti-inflammatory drugs (NSAIDs). Outcomes included quality-adjusted life years (QALYs), lifetime medical costs, and incremental cost-effectiveness ratios (ICERs). We considered cohorts with mean ages 57–75 years and Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain 25–55 (0–100, 100-worst). We derived inputs from published data. We discounted costs and benefits 3% annually. We conducted sensitivity analyses of duloxetine efficacy, duration of pain relief, toxicity, and costs. Among younger subjects with severe pain (WOMAC pain=55), duloxetine led to an additional 9.6 QALYs per 1000 subjects (ICER=$88,500/QALY). The likelihood of duloxetine being cost-effective at willingness-to-pay (WTP) thresholds of $50,000/QALY and $100,000/QALY was 40% and 54%. Offering duloxetine to older patients with severe pain led to ICERs >$150,000/QALY. Offering duloxetine to subjects with moderate pain (pain=25) led to ICERs <$50,000/QALY, regardless of age. Among knee OA subjects with severe pain (pain=55) who are unwilling or unable to undergo TKR, ICERs were <$50,600/QALY, regardless of age. Duloxetine is a cost-effective addition to knee OA UC for subjects with moderate pain or those with severe pain unable or unwilling to undergo TKR. Among younger subjects with severe pain, duloxetine is cost-effective at WTP thresholds >$88,500/QALY.
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影响因子：
3.4
作者：
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通讯作者：
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作者：
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Katz, Jeffrey N.
影响因子：
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作者：
Katz JN;Smith SR;Collins JE;Solomon DH;Jordan JM;Hunter DJ;Suter LG;Yelin E;Paltiel AD;Losina E
通讯作者：
Losina E