Excluded economic studies

National Clinical Guideline Centre (UK)

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National Clinical Guideline Centre (UK). Osteoarthritis: Care and Management in Adults. London: National Institute for Health and Care Excellence (UK); 2014 Feb. (NICE Clinical Guidelines, No. 177.)

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Update information: December 2020: in the recommendation on adding opioid analgesics NICE added links to other NICE guidelines and resources that support discussion with patients about opioid prescribing and safe withdrawal management. For the current recommendations, see www.nice.org.uk/guidance/CG177/chapter/recommendations.

Update information: December 2020: in the recommendation on adding opioid analgesics NICE added links to other NICE guidelines and resources that support discussion with patients about opioid prescribing and safe withdrawal management. For the current recommendations, see www.nice.org.uk/guidance/CG177/chapter/recommendations.

Osteoarthritis: Care and Management in Adults.

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Appendix KExcluded economic studies

Table 7Studies excluded from the economic review

Reference	Reason for exclusion
CG59 studies selectively excluded
YEN 2004^*	This study was felt to have methodological limitations and thus evidence statements could not be made from it in CG59. Study was not applicable due to: - Non-relevant comparators (hyaluronan compared with celecoxib and naproxen) - Non-OECD study setting limits usefulness
WADDELL 2001^*	This study was felt to have methodological limitations and thus evidence statements could not be made from it in CG59. Study was only partially applicable due to - Not being a cost effectiveness analysis (it assumes hyaluronan injections reduce the need for total knee replacements, and evaluates the costs with and without the injections) - Has USA setting. Additionally it has very serious limitations due to: - The duration used is not appropriate for the modelling assumptions. This is because the paper assumes the injections delay knee replacement for about 1 year, however the paper only has a time horizon of 3 years. The results of the study are therefore slightly misleading because it implies a cost saving from the injections because of the delayed surgery, however in reality, these costs would accrue the following year. So because of the short time horizon and therefore future costs not being included, the results can be confusing.
KAHAN 2003^*	This study was felt to have methodological limitations and thus evidence statements could not be made from it in CG59. Study was only partially applicable due to: - Not a cost utility study - Not much information on what conventional treatment arm involves - French setting; reimbursement regime differs. Additionally, it has potentially serious limitations due to: - French reimbursement system and full costs not being included.
TORRANCE 2002^*	This study was felt to have methodological limitations and thus evidence statements could not be made from it in CG59. Study was only partially applicable due to: - Canadian setting - Interventions may not be appropriate: Little data on what ‘appropriate care’ involves. Also in both groups some patients have steroid injections. Additionally, it has potentially serious limitations due to: - Trial was not blinded - Unclear as to whether the analysis allows comparison of hyaluronan treatment with steroid injections, as some patients in the hyaluronan arm receive both.
Update guideline studies selectively excluded
MAZIERES 2007 (Hyaluronan review)	Study is only partially applicable due to: - Not a cost effectiveness analysis - No comparator - It is a French study with a healthcare setting different to that of UK - Does not use QALYs. Additionally, it has potentially/very serious limitations due to: - No randomisation due to their being no comparator - Poor study design - Doesn’t include the full costs of the interventions/treatments - Short time horizon - No sensitivity analysis.

*: These studies from CG59 were seen to have methodological limitations and therefore evidence statements were not made from these. Thus they have been excluded in the update guideline.

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National Clinical Guideline Centre (UK). Osteoarthritis: Care and Management in Adults. London: National Institute for Health and Care Excellence (UK); 2014 Feb. (NICE Clinical Guidelines, No. 177.) Appendix K, Excluded economic studies.
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