Cost-effectiveness of nonsteroidal anti-inflammatory drugs and opioids in the treatment of knee osteoarthritis in older patients with multiple comorbidities

Osteoarthritis Cartilage. 2016 Mar;24(3):409-18. doi: 10.1016/j.joca.2015.10.006. Epub 2015 Oct 23.

Abstract

Objective: To evaluate long-term clinical and economic outcomes of naproxen, ibuprofen, celecoxib or tramadol for OA patients with cardiovascular disease (CVD) and diabetes.

Design: We used the Osteoarthritis Policy Model to examine treatment with these analgesics after standard of care (SOC) - acetaminophen and corticosteroid injections - failed to control pain. NSAID regimens were evaluated with and without proton pump inhibitors (PPIs). We evaluated over-the-counter (OTC) regimens where available. Estimates of treatment efficacy (pain reduction, occurring in ∼57% of patients on all regimens) and toxicity (major cardiac or gastrointestinal toxicity or fractures, risk ranging from 1.09% with celecoxib to 5.62% with tramadol) were derived from published literature. Annual costs came from Red Book Online(®). Outcomes were discounted at 3%/year and included costs, quality-adjusted life expectancy, and incremental cost-effectiveness ratios (ICERs). Key input parameters were varied in sensitivity analyses.

Results: Adding ibuprofen to SOC was cost saving, increasing QALYs by 0.07 while decreasing cost by $800. Incorporating OTC naproxen rather than ibuprofen added 0.01 QALYs and increased costs by $300, resulting in an ICER of $54,800/QALY. Using prescription naproxen with OTC PPIs led to an ICER of $76,700/QALY, while use of prescription naproxen with prescription PPIs resulted in an ICER of $252,300/QALY. Regimens including tramadol or celecoxib cost more but added fewer QALYs and thus were dominated by several of the naproxen-containing regimens.

Conclusions: In patients with multiple comorbidities, naproxen- and ibuprofen-containing regimens are more effective and cost-effective in managing OA pain than opioids, celecoxib or SOC.

Keywords: Cost-effectiveness; NSAIDS; Nonsteroidal anti-inflammatory drugs; Opioids; Osteoarthritis.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / economics
  • Analgesics, Opioid / therapeutic use*
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / economics
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use*
  • Celecoxib / adverse effects
  • Celecoxib / economics
  • Celecoxib / therapeutic use
  • Comorbidity
  • Cost-Benefit Analysis
  • Drug Costs / statistics & numerical data
  • Drug Therapy, Combination / economics
  • Female
  • Health Services Research / methods
  • Humans
  • Ibuprofen / adverse effects
  • Ibuprofen / economics
  • Ibuprofen / therapeutic use
  • Male
  • Middle Aged
  • Naproxen / adverse effects
  • Naproxen / economics
  • Naproxen / therapeutic use
  • Nonprescription Drugs / economics
  • Nonprescription Drugs / therapeutic use
  • Osteoarthritis, Knee / drug therapy*
  • Osteoarthritis, Knee / economics*
  • Pain / drug therapy
  • Pain / economics
  • Pain Measurement / methods
  • Proton Pump Inhibitors / economics
  • Proton Pump Inhibitors / therapeutic use
  • Quality-Adjusted Life Years
  • Sensitivity and Specificity
  • Tramadol / adverse effects
  • Tramadol / economics
  • Tramadol / therapeutic use
  • Treatment Outcome
  • United States

Substances

  • Analgesics, Opioid
  • Anti-Inflammatory Agents, Non-Steroidal
  • Nonprescription Drugs
  • Proton Pump Inhibitors
  • Tramadol
  • Naproxen
  • Celecoxib
  • Ibuprofen