Background/Purpose: Knee osteoarthritis (KOA) affects 13.8% of the US population aged ≥26, causing significant burden-of-illness. We compared the cost-effectiveness of conventional medicines such as non-steroidal anti-inflammatory drugs (NSAIDs) and celecoxib (CXB) with complementary and alternative medicines (CAM) therapies to treat KOA from the US health care payers’ and patients’ perspectives, with 24-week, 2-year, and 10-year time-horizons. 

Methods: We constructed a Markov cohort model (10-year analysis) and a decision-tree model (24-week and 2-year analyses). All costs were obtained from the published literature (converted to 2012 USD) and included both direct and indirect health care costs of medications, drug-associated adverse events, and total knee replacement surgery. Clinical efficacies for treatment strategies were obtained from the Glucosamine/CS Arthritis Intervention Trial (GAIT). Effectiveness was measured using quality-adjusted life-years (QALYs) gained, estimated from the SF-6D data collected during GAIT. Patients were stratified into mild pain only and moderate-to-severe pain groups based on their severity of knee pain. Published literature was used to obtain the rest of the modeling parameters. Base-case results were varied in both one-way and probabilistic sensitivity analyses. 

Results: We found that, among the mild, moderate, and severe patients together (from time-horizon of 24 weeks and years 2 and 10), CAM therapies were cost-effective versus conventional medicines to treat KOA in the US, with CS being the most cost-effective treatment ($1,332 per QALY gained) and glucosamine the next most cost-effective ($ 120,367 per additional QALY gained).  However, in a 24 week time-horizon among KOA patients with mild pain CXB was also incrementally cost-effective versus CS ($49,988 per QALY gained). Among moderate-to-severe pain patients from 24-week time-horizon, the combination of glucosamine and CS was the most cost-effective ($3,279 per QALY gained). A major driver of cost-effectiveness of CAM therapies over conventional medicines in the 10 year time horizon was the lack of evidence of adverse events (AEs), compared to NSAIDS and CXB which have extensively-documented AEs. 

Conclusion: Our analysis indicates CAM therapies to be more cost-effective than conventional medicines in treating KOA, due to lack of known adverse events rates and lower drug utilization costs from CAM. Prescribers may want to consider the findings of our study; however, future research is needed regarding the long-term effectiveness and safety of CAM therapies in treating KOA

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cost-effectiveness-of-glucosamine-chondroitin-sulfate-their-combination-celecoxibnon-selective-non-steroidal-anti-inflammatory-drugs-and-placebo-in-treating-knee-osteoarthritis/