[en] INTRODUCTION: The aim of this study was to explore the cost-effectiveness of glucosamine sulphate (GS) compared with paracetamol and placebo (PBO) in the treatment of knee osteoarthritis. For this purpose, a 6-month time horizon and a health care perspective was used. MATERIAL AND METHODS: The cost and effectiveness data were derived from Western Ontario and McMaster Universities Osteoarthritis Index data of the Glucosamine Unum In Die (once-a-day) Efficacy trial study by Herrero-Beaumont et al. Clinical effectiveness was converted into utility scores to allow for the computation of cost per quality-adjusted life year (QALY) For the three treatment arms Incremental Cost-Effectiveness Ratio were calculated and statistical uncertainty was explored using a bootstrap simulation. RESULTS: In terms of mean utility score at baseline, 3 and 6 months, no statistically significant difference was observed between the three groups. When considering the mean utility score changes from baseline to 3 and 6 months, no difference was observed in the first case but there was a statistically significant difference from baseline to 6 months with a p-value of 0.047. When comparing GS with paracetamol, the mean baseline incremental cost-effectiveness ratio (ICER) was dominant and the mean ICER after bootstrapping was -1376 euro/QALY indicating dominance (with 79% probability). When comparing GS with PBO, the mean baseline and after bootstrapping ICER were 3617.47 and 4285 euro/QALY, respectively. CONCLUSION: The results of the present cost-effectiveness analysis suggested that GS is a highly cost-effective therapy alternative compared with paracetamol and PBO to treat patients diagnosed with primary knee OA.
Disciplines :
General & internal medicine
Author, co-author :
SCHOLTISSEN, Sophie ; Centre Hospitalier Universitaire de Liège - CHU > HOSPITALISATION - REVALIDATION ESNEUX
Bruyère, Olivier ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
NEUPREZ, Audrey ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Severens, J. L.
Herrero-Beaumont, G.
Rovati, L.
Hiligsmann, Mickaël ; Université de Liège - ULiège > HEC-Ecole de gestion : UER > Economie industrielle
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Language :
English
Title :
Glucosamine sulphate in the treatment of knee osteoarthritis: cost-effectiveness comparison with paracetamol.
Bijlsma JW, Knahr K. Strategies for the prevention and management of osteoarthritis of the hip and knee. Best Pract Res Clin Rheumatol 2007 21 : 59 76.
Bruyere O, Burlet N, Delmas PD, Rizzoli R, Cooper C, Reginster JY. Evaluation of symptomatic slow-acting drugs in osteoarthritis using the GRADE system. BMC Musculoskelet Disord 2008 9 : 165.
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.
McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and meta-analysis. JAMA 2000 283 : 1469 1475.
Vlad SC, LaValley MP, McAlindon TE, Felson DT. Glucosamine for pain in osteoarthritis: why do trial results differ? Arthritis Rheum 2007 56 : 2267 2277.
Richy F, Bruyere O, Ethgen O, Cucherat M, Henrotin Y, Reginster JY. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis. Arch Intern Med 2003 163 : 1514 1522.
Reginster JY. The efficacy of glucosamine sulfate in osteoarthritis: financial and nonfinancial conflict of interest. Arthritis Rheum 2007 56 : 2105 2110.
Herrero-Beaumont G, Ivorra JA, Del Carmen Trabado M et al. Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: a randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator. Arthritis Rheum 2007 56 : 555 567.
Pavelka K, Gatterova J, Olejarova M, Machacek S, Giacovelli G, Rovati LC. Glucosamine Sulfate Use and Delay of Progression of Knee Osteoarthritis: a 3-Year, Randomized, Placebo-Controlled, Double-blind Study. Arch Intern Med 2002 162 : 2113 2123.
Reginster JY, Deroisy R, Rovati LC et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. Lancet 2001 357 : 251 256.
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988 15 : 1833 1840. (Pubitemid 19037656)
Horsman J, Furlong W, Feeny D, Torrance G. The Health Utilities Index (HUI(R)): concepts, measurement properties and applications. Health and Quality of Life Outcomes 2003 1 : 54. (Pubitemid 39111942)
Grootendorst P, Marshall D, Pericak D, Bellamy N, Feeny D, Torrance GW. 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. (Pubitemid 46364008)
Glick H, Doshi J, Sonnad S, Polsky D. Economic Evaluation in Clinical Trials.
Drummond MF, Sculpher MJ, Torrance GW, O'Brien BJ, S GL. Methods for the Economic Evaluation of Health Care Programmes.
Lekkerkerker F, Kanis JA, Alsayed N et al. Adherence to treatment of osteoporosis: a need for study. Osteoporos Int 2007 18 : 1311 1317. (Pubitemid 47389473)
IMS. Intercontinental Marketing Services. http://www.imshealth.com (accessed June 2009).
Black W. The CE plane: a graphic representation of cost-effectiveness. Med Decis Making 1990 10 : 212 214. (Pubitemid 20311440)
Efron B, Tibshirani RJ. An Introduction to the Bootstrap.
Fenwick E, O'Brien BJ, Briggs A. Cost-effectiveness acceptability curves: facts, fallacies and frequently asked questions. Health Econ 2004 13 : 405 415. (Pubitemid 38660390)
NICE. Guide to the Methods of Health Technology Appraisal.
Owens DK. Interpretation of cost-effectiveness analyses. J Gen Intern Med 1998 13 : 716 717.
Rovira J, Antonanzas F. Economic analysis of health technologies and programmes. A Spanish proposal for methodological standardisation. Pharmacoeconomics 1995 8 : 245 252.
Graf von der Schulenburg JM, Hoffmann C. Review of European guidelines for economic evaluation of medical technologies and pharamceuticals. HEPAC 2000 1 : 2 8.
Barton G, Sach T, Jenkinson C, Avery A, Doherty M, Muir K. Do estimates of cost-utility based on the EQ-5D differ from those based on the mapping of utility scores? Health and Quality of Life Outcomes 2008 6 : 51.
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 in Health 2008 11 : 470 477. (Pubitemid 351712972)
