PMID- 24877251
OWN - NLM
STAT- MEDLINE
DCOM- 20140612
LR  - 20191027
IS  - 2151-4658 (Electronic)
IS  - 2151-464X (Linking)
VI  - 66
IP  - 5
DP  - 2014 May
TI  - Cost effectiveness of duloxetine for osteoarthritis: a Quebec societal 
      perspective.
PG  - 702-8
AB  - OBJECTIVE: To assess the cost effectiveness of duloxetine compared to other oral 
      postacetaminophen treatments for osteoarthritis (OA) from a Quebec societal 
      perspective. METHODS: A cost-utility analysis was performed enhancing the Markov 
      model from the 2008 OA guidelines of the National Institute for Health and 
      Clinical Excellence (NICE). The NICE model was extended to include opioid and 
      antidepressant comparators, adding titration, discontinuation, and relevant 
      adverse events (AEs). Comparators included duloxetine, celecoxib, diclofenac, 
      naproxen, hydromorphone, and oxycodone extended release (oxycodone). AEs included 
      gastrointestinal and cardiovascular events associated with nonsteroidal 
      antiinflammatory drugs (NSAIDs), as well as fracture, opioid abuse, and 
      constipation, among others. Costs and incremental cost-effectiveness ratios 
      (ICERs) were estimated in 2011 Canadian dollars. The base case modeled a cohort 
      of 55-year-old patients with OA for a 12-month period of treatment, followed by 
      treatment from a basket of post-discontinuation oral therapies until death. 
      Sensitivity analyses (one-way and probabilistic) were conducted. RESULTS: 
      Overall, naproxen was the least expensive treatment, whereas oxycodone was the 
      most expensive. Duloxetine accumulated the highest number of quality-adjusted 
      life years (QALYs), with an ICER of $36,291 per QALY versus celecoxib. Duloxetine 
      was dominant over opioids. In subgroup analyses, ICERs for duloxetine versus 
      celecoxib were $15,619 and $20,463 for patients at high risk of NSAID-related AEs 
      and patients ages >65 years, respectively. CONCLUSION: Duloxetine was cost 
      effective for a cohort of 55-year-old patients with OA, and more so in older 
      patients and those with greater AE risks.
FAU - Wielage, Ronald C
AU  - Wielage RC
FAU - Patel, Ankur J
AU  - Patel AJ
FAU - Bansal, Megha
AU  - Bansal M
FAU - Lee, Shannon
AU  - Lee S
FAU - Klein, Robert W
AU  - Klein RW
FAU - Happich, Michael
AU  - Happich M
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Arthritis Care Res (Hoboken)
JT  - Arthritis care & research
JID - 101518086
RN  - 0 (Analgesics)
RN  - 0 (Analgesics, Opioid)
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Thiophenes)
RN  - 9044SC542W (Duloxetine Hydrochloride)
SB  - IM
MH  - Analgesics/economics/therapeutic use
MH  - Analgesics, Opioid/*economics/therapeutic use
MH  - Anti-Inflammatory Agents, Non-Steroidal/*economics/therapeutic use
MH  - Cohort Studies
MH  - Cost-Benefit Analysis
MH  - Duloxetine Hydrochloride
MH  - Female
MH  - Humans
MH  - Male
MH  - Markov Chains
MH  - Middle Aged
MH  - Osteoarthritis/drug therapy/*economics/*epidemiology
MH  - Quebec/epidemiology
MH  - Socioeconomic Factors
MH  - Thiophenes/*economics/therapeutic use
EDAT- 2014/05/31 06:00
MHDA- 2014/06/13 06:00
CRDT- 2014/05/31 06:00
PHST- 2014/05/31 06:00 [entrez]
PHST- 2014/05/31 06:00 [pubmed]
PHST- 2014/06/13 06:00 [medline]
AID - 10.1002/acr.22224 [doi]
PST - ppublish
SO  - Arthritis Care Res (Hoboken). 2014 May;66(5):702-8. doi: 10.1002/acr.22224.