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Can we reduce disease burden from osteoarthritis?

Leonie Segal, Susan E Day, Adam B Chapman and Richard H Osborne
Med J Aust 2004; 180 (5 Suppl): S11.

Summary

  • The comparison of disparate interventions for the prevention and management of osteoarthritis (OA) is limited by the quality and quantity of published efficacy studies and the use of disparate measures for reporting clinical trial outcomes.

  • The “transfer to utility” technique was used to translate published trial outcomes into a health-related quality-of-life (utility) scale, creating a common metric which supported comparisons between disparate interventions.

  • Total hip replacement (THR) and total knee replacement (TKR) surgery were the most effective treatments and also highly cost-effective, at estimated cost per quality-adjusted life-year (QALY) of $7500 for THR and $10 000 for TKR (best estimate).

  • Other apparently highly cost-effective interventions were exercise and strength training for knee OA (< $5000/QALY), knee bracing, and use of capsaicin or glucosamine sulfate (< $10 000/QALY).

  • The cost per QALY estimates of non-specific and COX-2 inhibitor non-steroidal anti-inflammatory drugs were affected by treatment-related deaths and highly sensitive to the discounting of life-years lost.

  • OA interventions that have been shown to be ineffective (eg, arthroscopy) are targets for redistribution of healthcare resources.

  • OA interventions which lack efficacy studies (eg, prevention programs) require further research to assist priority setting.

  • The application of the Health-sector Wide model to OA demonstrates its role as an evidence-based model that can be successfully applied to identify marginal interventions — those to be expanded and contracted to reduce the expected burden of disease, within current healthcare resources.

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  • Leonie Segal1
  • Susan E Day2
  • Adam B Chapman3
  • Richard H Osborne4

  • 1 Health Economics Unit, Faculty of Business and Economics, Monash University, Melbourne, VIC.
  • 2 Centre for Rheumatic Diseases, Department of Medicine, University of Melbourne, Melbourne, VIC.


Acknowledgements: 

We acknowledge funding from the Population Health Division, Department of Health and Ageing (DHA) and thank the Advisory Panel (in alphabetical order) — N Bellamy, University of Queensland; N Bogduk, University of Newcastle; P Brooks, University of Queensland; H Brown, DHA; R Buchbinder, Monash University; M Cohen, RMIT. J Feller, Austin Repatriation Medical Centre; M Galea, University of Melbourne; S Garner, DHA; B Harrison, DHA; J Kelly, Community Representative Victoria; S Kirsa, Austin and Repatriation Medical Centre; D Lewis, Monash University; L March, Royal North Shore Hospital; G McColl, University of Melbourne; H McNeil, Arthritis Foundation of Victoria; C Sindall, DHA; C Stone, Department of Human Services, Victoria; and P Woodley, DHA.

Competing interests:

An Advisory Panel, including people from the DHA (see funding source, above), assisted by commenting on drafts and interpretation of the results. The authors controlled all intellectual decisions, and the views presented in this report are those of the researchers and not the DHA.

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