Can we reduce disease burden from osteoarthritis? An evidence-based priority-setting model

■ The comparison of disparate interventions for the prevention and management of osteoarthritis (OA) is limited by the quality and quantity of published efficacy studies and the use of disparate measures for reporting clinical trial outcomes. ■ The transfer to utility technique was used to translate published trial outcomes into a health-related quality-of-life (utility) scale, creating a common metric which supported comparisons between disparate interventions. ■ Total hip replacement (THR) and total knee replacement (TKR) surgery were the most effective treatments and also highly cost-effective, at estimated cost per quality-adjusted life-year (QALY) of $7500 for THR and $10 000 for TKR (best estimate). ■ Other apparently highly cost-effective interventions were exercise and strength training for knee OA (<$5000/QALY), knee bracing, and use of capsaicin or glucosamine sulfate (<$ 10 000/QALY). ■ The cost per QALY estimates of non-specific and COX-2 inhibitor non-steroidal anti-inflammatory drugs were affected by treatment-related deaths and highly sensitive to the discounting of life-years lost. ■ OA interventions that have been shown to be ineffective (eg, arthroscopy) are targets for redistribution of healthcare resources. ■ OA interventions which lack efficacy studies (eg, prevention programs) require further research to assist priority setting. ■ The application of the Health-sector Wide model to OA demonstrates its role as an evidence-based model that can be successfully applied to identify marginal interventions - those to be expanded and contracted to reduce the expected burden of disease, within current healthcare resources.