Clinical impact and cost-effectiveness of pain management in knee OA

描述(由申请人提供)：症状性膝骨性关节炎(OA)非常普遍，致残且费用高昂。与膝骨性关节炎相关的疼痛是与这种情况相关的残疾的主要驱动因素和伴随费用。骨性关节炎相关疼痛的治疗包括药物治疗、非药物治疗和手术治疗。临床医生和政策制定者面临着与膝骨性关节炎有效疼痛管理相关的关键问题：长期使用阿片类药物对患者的幸福感有何影响？合并症是如何影响药物选择和结果的？新型止痛药能以比现有疗法更低的毒性提供可持续的止痛吗？我们如何扩大锻炼和减肥干预措施，使这些计划能够惠及数百万可能从中受益的患者？需要作出哪些努力才能确保随着时间的推移充分遵守这些干预措施？在多大年龄和多大程度的功能状态下进行全膝关节置换术(TKR)是最佳的？我们建议使用一个经过验证的膝骨性关节炎自然病史和治疗结果的计算机模拟模型来解决这些问题和相关问题。我们评估了三种主要疼痛管理模式对膝骨性关节炎患者的健康和经济影响：1)阿片类药物的长期使用增加和传统药物的长期使用带来的挑战，以及新型止痛药带来的机遇；2)与实施、扩大和维持锻炼、减肥和行为干预的好处相关的机会和成本；以及3)手术选择的时机和顺序，包括单室和全膝关节置换术。我们组建了一个由风湿科医生、骨科医生、流行病学家、生物统计学家、决策分析师和健康经济学家组成的多学科专家团队，以评估“膝盖骨关节炎疼痛管理的临床影响和成本效益”。这项建议有以下三个具体目标：1.研究使用批准药物和研究药物治疗膝骨性关节炎的药物止痛策略的长期临床影响和成本-效果。2.研究在膝骨性关节炎患者中实施非药物治疗相关策略的临床和经济后果。3.评价膝关节骨性关节炎患者不同膝关节置换术的远期临床效果和成本-效果。该项目将指导临床医生和政策制定者努力减少膝盖骨关节炎患者的疼痛和残疾，提高他们的生活质量。

DESCRIPTION (provided by applicant): Symptomatic knee osteoarthritis (OA) is highly prevalent, disabling and costly. Pain related to knee OA is the principal driver of disability associated with this condition and attendant costs. Management of OA-related pain includes pharmacologic, non-pharmacologic, and surgical modalities. Clinicians and policy makers face critical questions related to effective pain management for knee OA: What is the impact of prolonged opioid use on patients' well-being? How do comorbidities affect medication choices and outcomes? Could novel analgesics offer sustainable pain relief at lower toxicity than currently available therapies? How do we scale up exercise and weight loss interventions to enable these programs to reach the millions of patients who might benefit from them? What efforts are needed to ensure adequate adherence to these interventions over time? At what age and level of functional status is it optimal to perform total knee replacement (TKR)? We propose to address these and related questions using a validated computer simulation model of knee OA natural history and treatment outcomes. We evaluate the health and economic effects of three major modalities of pain management in persons with knee OA: 1) the challenge posed by the increasing long-term use of opioids and by the chronic use of traditional pharmacologic agents in patients with comorbidities, along with the opportunities posed by novel analgesic agents; 2) the opportunities and costs associated with implementing, scaling up, and sustaining the benefits of exercise, weight loss, and behavioral interventions; and 3) the timing and sequencing of surgical options including unicompartmental and total knee replacement. We have assembled an expert multidisciplinary team of rheumatologists, orthopedists, epidemiologists, biostatisticians, decision analysts, and health economists to evaluate the "Clinical impact and cost-effectiveness of pain management in knee OA." This proposal has the following three specific aims: 1. To examine the long-term clinical impact and cost-effectiveness of pharmacologic analgesic strategies for knee OA that employ approved and investigational agents. 2. To examine the clinical and economic consequences of strategies related to the delivery of non- pharmacologic management in persons affected by knee OA. 3. To evaluate the long-term clinical impact and cost-effectiveness of alternative knee replacement strategies in persons with knee OA. This project will guide clinicians and policy makers in their efforts to reduce pain and disability and improve quality of life for people with knee OA.