Table 5.
Cost‑effectiveness estimates in the Americas (20 studies)
| Study | Country/region | Intervention and comparator | Δ Cost (US$) | Δ Effectiveness (QALY) | ICER (US$) | Cost-effectiveness threshold (US$) | Intervention cost effective? (+/−) |
|---|---|---|---|---|---|---|---|
| Traditional NSAIDs and/or coxibs | |||||||
| Loyd 2007 [46] | US | Celecoxib vs NSAIDs | $5205.96 | 0.1304 | $39,436.80 | $79,515/QALY | + |
| Bessette 2009 [48] | Canada | Celecoxib as first- vs second-line treatment | $1331.45 | 0.02 | $51,656.40 | NR | + |
| Wielage 2014 [60] | Canada | Celecoxib vs diclofenac | $53.10 | 0.0024 | $23,818.81 | $59,345/QALY | + |
| Losina 2018 [70] | US | Celecoxib vs OTC naproxen | $450.98 | 0.005 | $307,013.56 | $109,325/QALY | – |
| OTC naproxen + OTC PPIs vs OTC naproxen | $450.98 | 0.007 | $63,639.81 | $109,325/QALY | – | ||
| Kamath 2003 [42] | US | Ibuprofen vs acetaminophen | $71.23 | 0.08 | $875.91 | Cost-effectiveness acceptability curves | + |
| Wielage 2013 [54] | Canada | Duloxetine vs celecoxib | $624.72 | 0.0169 | $36,613.26 | $59,345/QALY | + |
| Wielage 2013 [55] | US | Duloxetine vs naproxen | $1458.94 | 0.0266 | $54,188.77 | $59,345/QALY | + |
| Wielage 2013 [56] | US | Duloxetine vs naproxen | $1533.73 | 0.0266 | $67,594.46 | $59,345/QALY | + |
| Katz 2016 [67] | US | Naproxen OTC vs ibuprofen | $426.13 | 0.007 | $60,139.76 | $112,726/QALY | + |
| Naproxen Rx + PPI OTC vs naproxen OTC | $2130.31 | 0.025 | $84,173.71 | $112,726/QALY | + | ||
| Sullivan 2021 [75] | US | Duloxetine + usual care vs usual care (57 years old and WOMAC pain 55) | $950.27 | 0.009 | $93,442.99 | $93,443/QALY | + |
| Duloxetine + usual care vs usual care (65 years old and WOMAC pain 55) | $844.68 | 0.005 | $167,458.29 | $93,443/QALY | + | ||
| Duloxetine + usual care vs usual care (75 years old and WOMAC pain 55) | $739.10 | 0 | Dominated2 | $93,443/QALY | + | ||
| Duloxetine + usual care vs usual care (57 years old and WOMAC pain 25) | $1372.61 | 0.031 | $45,296.09 | $93,443/QALY | + | ||
| Duloxetine + usual care vs usual care (65 years old and WOMAC pain 25) | $1267.02 | 0.03 | $40,755.93 | $93,443/QALY | + | ||
| Duloxetine + usual care vs usual care (75 years old and WOMAC pain 25) | $1161.44 | 0.03 | $40,755.93 | $93,443/QALY | + | ||
| IA injections | |||||||
| Torrance 2002 [45] | Canada | Hylan G-F 20 + appropriate care vs appropriate care (SP) | $791.71 | 0.071 | $11,150.83 | $31,754/QALY | + |
| (HP) | $786.13 | 0.071 | $11,072.71 | $31,754/QALY | + | ||
| Hatoum 2014 [59] | US | BioHA + conventional care vs conventional care | $1048.13 | 0.024 | $43,671.75 | $57,529/QALY | + |
| Bellamy 2016 [36] | US | Ketorolac vs corticosteroid (injection) | NR | NR | Dominant | NR | + |
| Rosen 2016 [68] | US | Euflexxa + conventional care vs conventional care | $574.82 | 0.115 | $4,998.46 | $54,663/QALY | + |
| Rosen 2019 [39] | US | HMW HA vs NSAID/analgesic medication | $273.33 | 0.026 | $10,512.77 | $51,534/QALY | + |
| Rosen 2020 [71] | US | HMW HA vs LMW HA | $87.61 | 0.029 | $3020.96 | $51,534/QALY | + |
| Samuelson 2020 [72] | US | PRP vs HA | $1477.66 | 0.11 | $13,015.63 | $51,534/QALY | + |
| Castro 2015 [65] | Colombia | Hylan G-F 20 vs CST | NR | NR | Dominant | NR | + |
| Opioids | |||||||
| Marshall 2006 [51] | US | Oxycodone vs oxycodone + paracetamol | $1054.90 | 0.0105 | $100,467.71 | $68,511–$137,022/QALY | + |
| Smith 2017 [69] | US | Tramadol vs opioid-sparing | $1999.77 | 0.04 | $42,765.01 | $111,098/QALY | - |
| Tramadol + oxycodone vs opioid-sparing | $5777.11 | 0.05 | $128,028.74 | $111,098/QALY | - | ||
CST conventional supportive therapy, HA hyaluronic acid, HMW high molecular weight, HP health care system perspective, IA intra-articular, ICER incremental cost-effectiveness ratio, LMW low molecular weight, NR not reported, NSAID non-steroidal anti-inflammatory drug, OTC over-the-counter, PPI proton pump inhibitor, PRP platelet-rich plasma, QALY quality-adjusted life-year, SP social perspective, WOMAC the Western Ontario McMaster University Osteoarthritis Index