Evidence map›Paper›PMID 33171315›Full record

ArticleOsteoarthritis and cartilage2021

Cost-effectiveness of duloxetine for knee OA subjects: the role of pain severity.

J K Sullivan, J Huizinga, R R Edwards, D J Hunter, T Neogi, E Yelin, J N Katz, E Losina

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Osteoarthritis and cartilage, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 1 pooled it
0.7field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.

  1. Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 4 institutions in 2 countries.

J K SullivanOrthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: jsullivan76@bwh.harvard.edu.
J HuizingaOrthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: jhuizinga@bwh.harvard.edu.
R R EdwardsDepartment of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: rredwards@bwh.harvard.edu.
D J HunterInstitute of Bone and Joint Research, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia. Electronic address: david.hunter@sydney.edu.au.
T NeogiBoston University School of Medicine, Boston, MA, USA. Electronic address: tneogi@bu.edu.
E YelinUniversity of California, San Francisco, CA, USA. Electronic address: Ed.Yelin@ucsf.edu.
J N KatzOrthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA; Departments of Epidemiology and Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA. Electronic address: jnkatz@bwh.harvard.edu.
E LosinaOrthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopedic Treatments (PIVOT), Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA. Electronic address: elosina@bwh.harvard.edu.
Brigham and Women's Hospital · USHarvard University · USRoyal North Shore Hospital · AUUniversity of California, San Francisco · US

Funding

VERITY: Value and Evidence in Rheumatology using bioInformaTics, and advanced analYticsP30AR072577 · NIAMS · BRIGHAM AND WOMEN'S HOSPITAL · PI Daniel Hal Solomon · 2017 to 2026
$9.8M
Research and Evaluation Support Core Unit (RESCU Core)P30AR072571 · NIAMS · BOSTON UNIVERSITY MEDICAL CAMPUS · PI TUHINA NEOGI · 2019 to 2026
$6.9M
Optimizing the value of pain management in knee OA patients with comorbiditiesR01AR074290 · NIAMS · BRIGHAM AND WOMEN'S HOSPITAL · PI Elena Losina · 2018 to 2026
$5.9M
Patient Oriented Research and Mentoring Program in OrthopedicsK24AR057827 · NIAMS · BRIGHAM AND WOMEN'S HOSPITAL · PI LOSINA, ELENA · 2010 to 2019
$1.7M
NIAMS NIH HHS K24 AR057827NIAMS NIH HHS P30 AR072571NIAMS NIH HHS P30 AR072577NIAMS NIH HHS R01 AR074290
6 · The paper itself

Abstract

objectiveEstablish the impact of pain severity on the cost-effectiveness of generic duloxetine for knee osteoarthritis (OA) in the United States.

designWe used a validated computer simulation of knee OA to compare usual care (UC) - intra-articular injections, opioids, and total knee replacement (TKR) - to UC preceded by duloxetine in those no longer achieving pain relief from non-steroidal anti-inflammatory drugs (NSAIDs). Outcomes included quality-adjusted life years (QALYs), lifetime medical costs, and incremental cost-effectiveness ratios (ICERs). We considered cohorts with mean ages 57-75 years and Western Ontario and McMaster Osteoarthritis Index (WOMAC) pain 25-55 (0-100, 100-worst). We derived inputs from published data. We discounted costs and benefits 3% annually. We conducted sensitivity analyses of duloxetine efficacy, duration of pain relief, toxicity, and costs.

resultsAmong younger subjects with severe pain (WOMAC pain = 55), duloxetine led to an additional 9.6 QALYs per 1,000 subjects (ICER = $88,500/QALY). The likelihood of duloxetine being cost-effective at willingness-to-pay (WTP) thresholds of $50,000/QALY and $100,000/QALY was 40% and 54%. Offering duloxetine to older patients with severe pain led to ICERs >$150,000/QALY. Offering duloxetine to subjects with moderate pain (pain = 25) led to ICERs <$50,000/QALY, regardless of age. Among knee OA subjects with severe pain (pain = 55) who are unwilling or unable to undergo TKR, ICERs were <$50,600/QALY, regardless of age.

conclusionsDuloxetine is a cost-effective addition to knee OA UC for subjects with moderate pain or those with severe pain unable or unwilling to undergo TKR. Among younger subjects with severe pain, duloxetine is cost-effective at WTP thresholds >$88,500/QALY.

Indexed as

Pain MeasurementAgedAnalgesicsAnalgesics, OpioidArthroplasty, Replacement, KneeComputer SimulationCost-Benefit AnalysisDuloxetine HydrochlorideGlucocorticoidsHumansInjections, Intra-ArticularMiddle AgedOsteoarthritis, KneeQuality-Adjusted Life YearsAnalgesicsAnalgesics, OpioidDuloxetine HydrochlorideGlucocorticoidsCost-effectivenessDuloxetineKnee osteoarthritis

Identifiers

PMID33171315
PMCPMC7814698
OpenAlexW3096431927

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.