Does gabapentin provide benefit for patients with knee OA? A benefit-harm and cost-effectiveness analysis

被引:4
|
作者
Bensen, G. P. [1 ,2 ,6 ]
Rogers, A. C. [1 ,2 ]
Leifer, V. P. [1 ,2 ]
Edwards, R. R. [3 ]
Neogi, T. [4 ]
Kostic, A. M. [1 ,2 ]
Paltiel, A. D. [5 ]
Collins, J. E. [1 ,2 ,6 ]
Hunter, D. J. [7 ,8 ]
Katz, J. N. [1 ,2 ,6 ,9 ,10 ]
Losina, E. [1 ,2 ,6 ,9 ,10 ,11 ]
机构
[1] Brigham & Womens Hosp, Orthopaed & Arthrit Ctr Outcomes Res OrACORe, Dept Orthopaed Surg, Boston, MA 02115 USA
[2] Brigham & Womens Hosp, Policy & Innovat eValuat Orthopaed Treatments PIVO, Dept Orthopaed Surg, Boston, MA 02115 USA
[3] Brigham & Womens Hosp, Dept Anesthesiol, Boston, MA 02115 USA
[4] Boston Univ, Sch Med, Boston, MA USA
[5] Yale Sch Publ Hlth, Publ Hlth Modeling Unit, New Haven, CT USA
[6] Harvard Med Sch, Boston, MA USA
[7] Univ Sydney, Inst Bone & Joint Res, Kolling Inst, Sydney, Australia
[8] Royal North Shore Hosp, Rheumatol Dept, Sydney, Australia
[9] Brigham & Womens Hosp, Div Rheumatol Inflammat & Immun, Boston, MA 02115 USA
[10] Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Orthopaed & Arthrit Ctr Outcomes Res OrACORe, Dept Orthopaed Surg, 75 Francis St,BTM 5016, Boston, MA 02115 USA
[11] Boston Univ, Sch Publ Hlth, Dept Biostat, Boston, MA USA
关键词
Gabapentin; Cost-efficacy; Knee osteoarthritis; Pain; NEUROPATHIC PAIN SYMPTOMS; CENTRAL SENSITIZATION; OSTEOARTHRITIS; MANAGEMENT; IMPACT; PREGABALIN; DULOXETINE; PEOPLE; HIP;
D O I
10.1016/j.joca.2022.07.013
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Objective: Gabapentin can treat neuropathic pain syndromes and has increasingly been prescribed to treat nociplastic pain. Some patients with knee osteoarthritis (OA) suffer from both nociceptive and nociplastic pain. We examined the cost-effectiveness of adding gabapentin to knee OA care.Method: We used the Osteoarthritis Policy Model, a validated Monte Carlo simulation of knee OA, to examine the value of gabapentin in treating knee OA by comparing three strategies: 1) usual care, gabapentin sparing (UC-GS); 2) targeted gabapentin (TG), which provides gabapentin plus usual care for those who screen positive for nociplastic pain on the modified PainDETECT questionnaire (mPD-Q) and usual care only for those who screen negative; and 3) universal gabapentin plus usual care (UG). Out-comes included cumulative quality-adjusted life years (QALYs), lifetime direct medical costs, and in-cremental cost-effectiveness ratios (ICERs), discounted at 3% annually. We derived model inputs from published literature and national databases and varied key input parameters in sensitivity analyses.Results: UC-GS dominated both gabapentin-containing strategies, as it led to lower costs and more QALYs. TG resulted in a cost increase of $689 and a cumulative QALY reduction of 0.012 QALYs. UG resulted in a further $1,868 cost increase and 0.036 QALY decrease. The results were robust to plausible changes in input parameters. The lowest TG strategy ICER of $53,000/QALY was reported when mPD-Q specificity was increased to 100% and AE rate was reduced to 0%. Conclusion: Incorporating gabapentin into care for patients with knee OA does not appear to offer good value.(c) 2022 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:279 / 290
页数:12
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