PMID- 23616247
OWN - NLM
STAT- MEDLINE
DCOM- 20140203
LR  - 20151119
IS  - 1179-1896 (Electronic)
IS  - 1175-5652 (Linking)
VI  - 11
IP  - 3
DP  - 2013 Jun
TI  - Cost-utility analysis of duloxetine in osteoarthritis: a US private payer 
      perspective.
PG  - 219-36
LID - 10.1007/s40258-013-0031-3 [doi]
AB  - BACKGROUND: Duloxetine has recently been approved in the USA for chronic 
      musculoskeletal pain, including osteoarthritis and chronic low back pain. The 
      cost effectiveness of duloxetine in osteoarthritis has not previously been 
      assessed. Duloxetine is targeted as post first-line (after acetaminophen) 
      treatment of moderate to severe pain. OBJECTIVE: The objective of this study was 
      to estimate the cost effectiveness of duloxetine in the treatment of 
      osteoarthritis from a US private payer perspective compared with other post 
      first-line oral treatments, including nonsteroidal anti-inflammatory drugs 
      (NSAIDs), and both strong and weak opioids. METHODS: A cost-utility analysis was 
      performed using a discrete-state, time-dependent semi-Markov model based on the 
      National Institute for Health and Clinical Excellence (NICE) model documented in 
      its 2008 osteoarthritis guidelines. The model was extended for opioids by adding 
      titration, discontinuation and additional adverse events (AEs). A life-long time 
      horizon was adopted to capture the full consequences of NSAID-induced AEs. 
      Fourteen health states comprised the structure of the model: treatment without 
      persistent AE, six during-AE states, six post-AE states and death. 
      Treatment-specific utilities were calculated using the transfer-to-utility method 
      and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total 
      scores from a meta-analysis of osteoarthritis clinical trials of 12 weeks and 
      longer. Costs for 2011 were estimated using Red Book, The Agency for Healthcare 
      Research and Quality's Healthcare Cost and Utilization Project database, the 
      literature and, sparingly, expert opinion. One-way and probabilistic sensitivity 
      analyses were undertaken, as well as subgroup analyses of patients over 65 years 
      old and a population at greater risk of NSAID-related AEs. RESULTS: In the base 
      case the model estimated naproxen to be the lowest total-cost treatment, 
      tapentadol the highest cost, and duloxetine the most effective after considering 
      AEs. Duloxetine accumulated 0.027 discounted quality-adjusted life-years (QALYs) 
      more than naproxen and 0.013 more than oxycodone. Celecoxib was dominated by 
      naproxen, tramadol was subject to extended dominance, and strong opioids were 
      dominated by duloxetine. The model estimated an incremental cost-effectiveness 
      ratio (ICER) of US$47,678 per QALY for duloxetine versus naproxen. One-way 
      sensitivity analysis identified the probabilities of NSAID-related cardiovascular 
      AEs as the inputs to which the ICER was most sensitive when duloxetine was 
      compared with an NSAID. When compared with a strong opioid, duloxetine dominated 
      the opioid under nearly all sensitivity analysis scenarios. When compared with 
      tramadol, the ICER was most sensitive to the costs of duloxetine and tramadol. In 
      subgroup analysis, the cost per QALY for duloxetine versus naproxen fell to 
      US$24,125 for patients over 65 years and to US$18,472 for a population at high 
      risk of cardiovascular and gastrointestinal AEs. CONCLUSION: The model estimated 
      that duloxetine was potentially cost effective in the base-case population and 
      more cost effective for subgroups over 65 years or at high risk of NSAID-related 
      AEs. In sensitivity analysis, duloxetine dominated all strong opioids in nearly 
      all scenarios.
FAU - Wielage, Ronald C
AU  - Wielage RC
AD  - Medical Decision Modeling Inc., 8909 Purdue Road, Suite #550, Indianapolis, IN 
      46268, USA. rwielage@mdm-inc.com
FAU - Bansal, Megha
AU  - Bansal M
FAU - Andrews, J Scott
AU  - Andrews JS
FAU - Klein, Robert W
AU  - Klein RW
FAU - Happich, Michael
AU  - Happich M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - New Zealand
TA  - Appl Health Econ Health Policy
JT  - Applied health economics and health policy
JID - 101150314
RN  - 0 (Analgesics)
RN  - 0 (Analgesics, Opioid)
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Thiophenes)
RN  - 9044SC542W (Duloxetine Hydrochloride)
SB  - IM
CIN - Appl Health Econ Health Policy. 2013 Oct;11(5):555-7. PMID: 23907656
CIN - Appl Health Econ Health Policy. 2013 Oct;11(5):553-4. PMID: 23918680
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Analgesics/economics/therapeutic use
MH  - Analgesics, Opioid/economics/therapeutic use
MH  - Anti-Inflammatory Agents, Non-Steroidal/economics/therapeutic use
MH  - Chronic Pain/drug therapy
MH  - Cost-Benefit Analysis
MH  - Duloxetine Hydrochloride
MH  - Female
MH  - Humans
MH  - Male
MH  - *Markov Chains
MH  - Middle Aged
MH  - *Models, Economic
MH  - Osteoarthritis/*drug therapy/*economics
MH  - Prescription Fees/statistics & numerical data
MH  - Thiophenes/*economics/therapeutic use
MH  - United States
EDAT- 2013/04/26 06:00
MHDA- 2014/02/04 06:00
CRDT- 2013/04/26 06:00
PHST- 2013/04/26 06:00 [entrez]
PHST- 2013/04/26 06:00 [pubmed]
PHST- 2014/02/04 06:00 [medline]
AID - 10.1007/s40258-013-0031-3 [doi]
PST - ppublish
SO  - Appl Health Econ Health Policy. 2013 Jun;11(3):219-36. doi: 
      10.1007/s40258-013-0031-3.