Chondroitin sulphate; economic analysis; osteoarthritis; quality of life
Abstract :
[en] Abstract Objectives: The first objective was to assess the effect of the chondroitin 4 and 6 sulphate (CS) on health-related quality of life using utility values in patients with knee osteoarthritis (OA) during a 24-month treatment course. The second objective was, using these data, to conduct economic analyses. Methods: Data from the STOPP study was used. This study was a randomised, double-blind, placebo (PL) -controlled trial of 2-year duration. In the STOPP study, authors assessed quality of life using the Western Ontario and McMaster Osteoarthritis Index (WOMAC). WOMAC scores were translated into Health Utility Index (HUI) scores using a specific formula. Incremental cost effectiveness ratio (ICER) was calculated taking into account the cost of CS and its effect on HUI scores, compared to PL. Results: At baseline, the mean (SD) HUI scores were 0.59 (0.17), and 0.59 (0.18) for the PL and CS groups, respectively (p=0.31 between the two groups). The mean (SD) HUI scores changes from baseline to 6 months were 0.02 (0.02), and 0.05 (0.01) for the PL and CS groups, respectively (p=0.03). After 24 months of follow-up, HUI score increases by 0.04 (0.02) in the PL group and by 0.05 (0.02) in the CS group (p=0.37). Using the price bracket of CS in Europe, ICER assessment always resulted in a cost below euro30,000 per QALY gained, after 6, 12 and 24 months of treatment. Conclusion: CS treatment increases health utilities in patients with knee OA compared to PL over the first 6 months of treatment. Economic evaluation based on these data suggests that CS treatment could be considered as cost-effective in patients with knee OA up to a period of 24 months. A limitation in this study is the absence of direct utility assessment as well as the absence of effective treatment as comparator.
Disciplines :
General & internal medicine
Author, co-author :
Bruyère, Olivier ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie et santé publique
SCHOLTISSEN, Sophie ; Centre Hospitalier Universitaire de Liège - CHU > HOSPITALISATION - REVALIDATION ESNEUX
NEUPREZ, Audrey ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Hiligsmann, Mickaël ; Université de Liège - ULiège > HEC-Ecole de gestion : UER > Economie industrielle
Toukouki, A.
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique > Epidémiologie et santé publique
Language :
English
Title :
Impact of chondroitin sulphate on health utility in patients with knee osteoarthritis: towards economic analysis.
Andrews G, Simonella L, Lapsley H, et al. Evidence-based medicine is affordable: the cost-effectiveness of current compared with optimal treatment in rheumatoid and osteoarthritis. J Rheumatol 2006;33:671-680
Bruyere O, Reginster JY. The need for economic evaluation in osteoarthritis. Aging Health 2009;5:591-594
Ruchlin HS, Insinga RP. A review of health-utility data for osteoarthritis: implications for clinical trial-based evaluation. Pharmacoeconomics 2008;26:925-935
Marshall JK, Pellissier JM, Attard CL, et al. Incremental cost-effectiveness analysis comparing rofecoxib with nonselective NSAIDs in osteoarthritis: Ontario Ministry of Health perspective. Pharmacoeconomics 2001;19:1039-1049
Contreras-Hernandez I, Mould-Quevedo JF, Torres-Gonzalez R, et al. Cost-effectiveness analysis for joint pain treatment in patients with osteoarthritis treated at the Instituto Mexicano del Seguro Social (IMSS): Comparison of nonsteroidal anti-inflammatory drugs (NSAIDs) vs. cyclooxygenase-2 selective inhibitors. Cost Eff Resour Alloc 2008;6:21.
Koskinen E, Eskelinen A, Paavolainen P, et al. Comparison of survival and cost-effectiveness between unicondylar arthroplasty and total knee arthroplasty in patients with primary osteoarthritis: a follow-up study of 50,493 knee replacements from the Finnish Arthroplasty Register. Acta Orthop 2008;79:499-507.
Soohoo NF, Sharifi H, Kominski G, et al. Cost-effectiveness analysis of unicompartmental knee arthroplasty as an alternative to total knee arthroplasty for unicompartmental osteoarthritis. J Bone Joint Surg Am 2006;88:1975-1982
Moore A, Phillips C, Hunsche E, et al. Economic evaluation of etoricoxib versus non-selective NSAIDs in the treatment of osteoarthritis and rheumatoid arthritis patients in the UK. Pharmacoeconomics 2004;22:643-660
Tavakoli M. Modelling therapeutic strategies in the treatment of osteoarthritis: an economic evaluation of meloxicam versus diclofenac and piroxicam. Pharmacoeconomics 2003;21:443-454
Al MJ, Maniadakis N, Grijseels EW, Janssen M. Costs and effects of various analgesic treatments for patients with rheumatoid arthritis and osteoarthritis in the Netherlands. Value Health 2008;11:589-599
Loyd M, Rublee D, Jacobs P. An economic model of long-term use of celecoxib in patients with osteoarthritis. BMC Gastroenterol 2007;7:25.
Kamath CC, Kremers HM, Vanness DJ, et al. The cost-effectiveness of acetaminophen, NSAIDs, and selective COX-2 inhibitors in the treatment of symptomatic knee osteoarthritis. Value Health 2003;6:144-157
Bruyere O, Reginster JY. Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis. Drugs Aging 2007;24:573-580
Bruyere O, Burlet N, Delmas PD, et al. Evaluation of symptomatic slow-acting drugs in osteoarthritis using the GRADE system. BMC Musculoskelet Disord 2008;9:165.
Zhang W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage 2008;16:137-162
Jordan KM, Arden NK, Doherty M, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003;62:1145-1155 (Pubitemid 37500619)
Kahan A, Uebelhart D, De Vathaire F, et al. Long-term effects of chondroitins 4 and 6 sulfate on knee osteoarthritis: the study on osteoarthritis progression prevention, a two-year, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2009;60:524-533
Grootendorst P, Marshall D, Pericak D, et al. A model to estimate health utilities index mark 3 utility scores from WOMAC index scores in patients with osteoarthritis of the knee. J Rheumatol 2007;34:534-542
Raftery J. NICE: faster access to modern treatments? Analysis of guidance on health technologies. Br Med J 2001;323:1300-1303
Bruyere O, Honore A, Rovati LC, et al. Radiologic features poorly predict clinical outcomes in knee osteoarthritis. Scand J Rheumatol 2002;31:13-16.
Dieppe PA. Why is there such a poor correlation between radiographic joint damage and both symptoms and functional impairment in osteoarthritis? Br J Rheumatol 1989;28:242.
Duncan R, Peat G, Thomas E, et al. Symptoms and radiographic osteoarthritis: not as discordant as they are made out to be? Ann Rheum Dis 2007;66:86-91.
Pattrick M, Hamilton E, Wilson R, et al. Association of radiographic changes of osteoarthritis, symptoms, and synovial fluid particles in 300 knees. Ann Rheum Dis 1993;52:97-103.
Cicuttini FM, Jones G, Forbes A, et al. Rate of cartilage loss at two years predicts subsequent total knee arthroplasty: a prospective study. Ann Rheum Dis 2004;63:1124-1127
Bruyere O, Richy F, Reginster JY. Three year joint space narrowing predicts long term incidence of knee surgery in patients with osteoarthritis: an eight year prospective follow up study. Ann Rheum Dis 2005;64:1727-1730
Marshall D, Pericak D, Grootendorst P, et al. Validation of a prediction model to estimate health utilities index Mark 3 utility scores from WOMAC index scores in patients with osteoarthritis of the hip. Value Health 2008;11:470-477
Barton GR, Sach TH, Jenkinson C, et al. Do estimates of cost-utility based on the EQ 5D differ from those based on the mapping of utility scores? Health Qual Life Outcomes 2008;6:51.