Economic evaluations have expanded to advanced models such as Markova and the Osteoarthritis Policy models that incorporate considerations for longer time ranges, health utility, a wider range of adverse events including cardiovascular events, and additional meaningful outcomes such as the cost per QALY ICERs.

Differences in study design and between health systems of different countries hampered meaningful comparison of results across studies.

The key drivers of cost effectiveness included medical resources, productivity, relative risks, and selected comparators.