Abstract and Introduction
Abstract
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 €/QALY indicating dominance (with 79% probability). When comparing GS with PBO, the mean baseline and after bootstrapping ICER were 3617.47 and 4285 €/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.
Introduction
Osteoarthritis (OA) is a major cause of disability and is among the most frequent forms of musculoskeletal disorders. It is a major public health problem for which there are few effective medical remedies. Current treatment options for OA include both non-pharmacological and pharmacological interventions. Published evidence-based recommendations for the treatment of knee OA have attributed to oral glucosamine sulphate (GS) the highest level of evidence and strength of recommendation as a pharmacological intervention.
Among several meta analyses that have scrutinised the efficacy of glucosamine in OA, one has particular merit because it concentrated on three pivotal studies by Herrero-Beaumont et al., Pavelka et al. and Reginster et al.. Actually, all other meta analyses, albeit showing the efficacy of glucosamine in general, found significant heterogeneity in the available studies as they pooled together trials with different design and quality, of short-term duration, examining different populations, performed with inadequate statistical power and, especially, with different glucosamine compounds, formulations and dosages. Conversely, Reginster found no heterogeneity in the three high quality trials that are characterised as pivotal and calculated a statistically significant and clinically relevant effect size of GS 1500 mg once-a-day.
As the disease occurs mainly in subjects over 50 years of age, the socio-economic impact of OA is becoming increasingly important as a result of the progressive ageing of the population in several countries. Therefore, with regard to the medico-economic pressure, it is essential to develop effective treatments and also efficient strategies. In a world with limited resources and health care budgets, it is important to allocate scarce resources efficiently. Economic evaluation is a method for comparing different strategies in terms of cost (i.e. intervention costs and disease costs) and consequences [i.e. life years or quality-adjusted life year (QALY)]. These evaluations play, in particular, an increasing role in pricing and reimbursement decisions as regulatory agencies rely more on pharmacoeconomic data to make decisions about limited resources.
The aim of this study was to explore the cost-effectiveness of GS compared with paracetamol and placebo (PBO) in the treatment of knee OA. For this purpose, a 6-month time horizon and a health care perspective was used.