Systematic review of the cost effectiveness of prophylactic treatments in the prevention of gastropathy in patients with rheumatoid arthritis or osteoarthritis taking non-steroidal anti-inflammatory drugs

Cost Effectiveness of Pharmacological Management for Osteoarthritis: A Systematic Review

BACKGROUND AND OBJECTIVE

Osteoarthritis (OA) is a highly prevalent, disabling disease requiring chronic management that is associated with an enormous individual and societal burden. This systematic review provides a global cost-effectiveness evaluation of pharmacological therapy for the management of OA.

METHODS

Following Center for Reviews and Dissemination (CRD) guidance, a literature search strategy was undertaken using PubMed, EMBASE, Cochrane Library, Health Technology Assessment (HTA) database, and National Health Service Economic Evaluation database (NHS EED) to identify original articles containing cost-effectiveness evaluation of OA pharmacological treatment published before 4 November 2021. Risk of bias was assessed by two independent reviewers using the Joanna Briggs Institute (JBI) critical appraisal checklist for economic evaluations. The Quality of Health Economic Studies (QHES) instrument was used to assess the reporting quality of included articles.

RESULTS

Database searches identified 43 cost-effectiveness analysis studies (CEAs) on pharmacological management of OA that were conducted in 18 countries and four continents, with one study containing multiple continents. A total of four classes of drugs were assessed, including non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, symptomatic slow-acting drugs for osteoarthritis (SYSADOAs), and intra-articular (IA) injections. The methodological approaches of these studies showed substantial heterogeneity. The incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-year (QALY) were (in 2021 US dollars) US$44.40 to US$307,013.56 for NSAIDS, US$11,984.84 to US$128,028.74 for opioids, US$10,930.17 to US$27,799.73 for SYSADOAs, and US$258.36 to US$58,447.97 for IA injections in different continents. The key drivers of cost effectiveness included medical resources, productivity, relative risks, and selected comparators.

CONCLUSION

This review showed substantial heterogeneity among studies, ranging from a finding of dominance to very high ICERs, but most studies found interventions to be cost effective based on specific ICER thresholds. Important challenges in the analysis were related to the standardization and methodological quality of studies, as well as the presentation of results.

Clinical evaluation of Vatari guggulu, Maharasnadi kwatha and Narayan taila in the management of osteoarthritis knee

BACKGROUND

In present era, pharmacological, bio-chemical and surgical interventions are not success remedy for Osteoarthritis (OA). Ayurveda and other complementary medicine have medication for OA.

OBJECTIVES

The main aim of the study was to assess the efficacy and safety of therapeutic combination of Vatari guggulu along with Maharasnadi kwatha and Narayan taila with gentle massage for 15 min daily up to 12 weeks on affected knee joint pain assessed on Visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

MATERIALS AND METHODS

It was an open label, multicentre, prospective, clinical study conducted on 142 patients of OA Knee. Vatari guggulu 500 mg thrice in a day along with Maharasnadi kwatha 20 ml with equal amount of water twice daily and Narayan taila 20 ml twice in a day for external application with gentle massage for 15 min up to 12 weeks were used to all the study participants.

RESULTS

VAS, WOMAC score and clinical symptoms were reduced significantly from baseline to end of the treatment (P < 0.001).

CONCLUSIONS

The study provides good evidence in support of the efficacy and safety of the Vatari guggulu along with Maharasnadi kwatha and Narayan taila in the management of Osteoarthritis knee.

Testing a theory of chronic pain

BACKGROUND

Chronic pain is highly prevalent among older people with arthritis, with depression as its major outcome. The psychopathological process of chronic pain and its outcomes in older people with arthritis have not been the subject of extensive research. The purpose of this study was to test a middle-range theory of chronic pain derived from the Roy Adaptation Model, a nursing theory whose validity has not been tested in the context of chronic pain.

METHODS

The study used a convenience sample of 71 older people with arthritis. Two subscales of the Arthritis Impact Measurement Scales were used to measure pain and physical disability. Social support was measured by Part II of the Personal Resource Questionnaire, and the Elderly Daily Stress scale was used to measure daily stress. Participants also completed the 10-item Center for Epidemiological Studies of Depression scale. Univariate analysis, correlation, and path analysis were used to analyse the data.

RESULTS

Overall, the data supported the hypothesized model in which pain, disability, social support, age, and gender are predictors of daily stress and daily stress further predicts depression. The direct effects of chronic pain, disability, and social support accounted for 37% of the variance of daily stress, which in turn predicted 35% of the variance of depression. Age and gender had no influence on daily stress. The chi-square index suggested a fit between the data and the model, and therefore the current model is temporarily accepted. Other fit indices also showed a good fit of the model to the data. To simplify the model, a revised version was developed.

CONCLUSIONS

This study validated a middle-range theory to explain the effects of chronic pain in older people with arthritis and highlights the importance of chronic pain in the development of depression.