التفاصيل البيبلوغرافية
| العنوان: |
Cost-Effectiveness of Tramadol and Oxycodone in the Treatment of Knee Osteoarthritis. |
| المؤلفون: |
Smith, Savannah R., Katz, Jeffrey N., Collins, Jamie E., Solomon, Daniel H., Jordan, Joanne M., Suter, Lisa G., Yelin, Edward H., David Paltiel, A., Losina, Elena |
| المصدر: |
Arthritis Care & Research; Feb2017, Vol. 69 Issue 2, p234-242, 9p |
| مصطلحات موضوعية: |
THERAPEUTIC use of narcotics, ANALGESICS, COMPUTER simulation, COST effectiveness, KNEE diseases, NARCOTICS, OSTEOARTHRITIS, RESEARCH funding, OXYCODONE, FERRANS & Powers Quality of Life Index, TRAMADOL, IMPACT of Event Scale, ECONOMICS, THERAPEUTICS |
| مستخلص: |
Objective: To evaluate the cost-effectiveness of incorporating tramadol or oxycodone into knee osteoarthritis (OA) treatment.Methods: We used the Osteoarthritis Policy Model to evaluate long-term clinical and economic outcomes of knee OA patients with a mean age of 60 years with persistent pain despite conservative treatment. We evaluated 3 strategies: opioid-sparing (OS), tramadol (T), and tramadol followed by oxycodone (T+O). We obtained estimates of pain reduction and toxicity from published literature and annual costs for tramadol ($600) and oxycodone ($2,300) from Red Book Online. Based on published data, in the base case, we assumed a 10% reduction in total knee arthroplasty (TKA) effectiveness in opioid-based strategies. Outcomes included quality-adjusted life years (QALYs), lifetime cost, and incremental cost-effectiveness ratios (ICERs) and were discounted at 3% per year.Results: In the base case, T and T+O strategies delayed TKA by 7 and 9 years, respectively, and led to reduction in TKA utilization by 4% and 10%, respectively. Both opioid-based strategies increased cost and decreased QALYs compared to the OS strategy. Tramadol's ICER was highly sensitive to its effect on TKA outcomes. Reduction in TKA effectiveness by 5% (compared to base case 10%) resulted in an ICER for the T strategy of $110,600 per QALY; with no reduction in TKA effectiveness, the ICER was $26,900 per QALY. When TKA was not considered a treatment option, the ICER for T was $39,600 per QALY.Conclusion: Opioids do not appear to be cost-effective in OA patients without comorbidities, principally because of their negative impact on pain relief after TKA. The influence of opioids on TKA outcomes should be a research priority. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
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