December 17, 2020
2 min learn
The researchers report funding help from the NIH. Lenhard studies no related monetary disclosures. Please see the research for all different authors’ related monetary disclosures.
Including the antidepressant duloxetine to regular take care of knee osteoarthritis with average ache, no matter any despair screening or signs, is price efficient, based on findings revealed in Arthritis Care & Analysis.
“Duloxetine, a serotonin-norepinephrine reuptake inhibitor that’s FDA-approved for main depressive dysfunction and knee OA, is efficient in treating despair and OA ache impartial of depressive signs,” Nora Okay. Lenhard, BA, of Brigham and Ladies’s Hospital, in Boston, and colleagues wrote. “Given the damaging affect despair has on OA administration, incorporating a remedy that might have an effect on each situations concurrently may enhance outcomes. Duloxetine can also alleviate a number of the financial burden posed by medical prices related to despair by resulting in remission.”
“Nonetheless, whereas despair screening is really useful for all adults and could also be particularly necessary on this inhabitants, some research elevate questions concerning the feasibility and efficacy of incorporating screening into routine care,” they added. “Moreover, rheumatologists and orthopedists could also be reluctant to display for despair attributable to time constraints or feeling that different suppliers can be higher suited to despair administration.”
To investigate the fee effectiveness of including duloxetine (Cymbalta, Eli Lilly & Co.) to plain knee OA care, no matter despair screening, Lenhard and colleagues in contrast three methods utilizing the Osteoarthritis Coverage Mannequin, a validated pc microsimulation of knee OA. The three included methods have been commonplace care; commonplace care plus duloxetine solely for many who display optimistic for despair on the Affected person Well being Questionnaire 9 (PHQ‐9); and common duloxetine plus commonplace care. Key outcomes included high quality‐adjusted life years (QALYs), lifetime direct medical prices and incremental price‐effectiveness ratios (ICERs), discounted at 3% yearly.
The researchers drew their mannequin inputs revealed literature and nationwide databases. These included: $721 to $937 for the annual price of duloxetine, a WOMAC rating of 17.5 as the typical ache discount for duloxetine, and a 27.4% probability of despair remission with duloxetine. As well as, they examined two willingness‐to‐pay (WTP) thresholds — $50,000/QALY and $100,000/QALY. Lastly, the researchers addressed uncertainty within the mannequin inputs by various the parameters associated to the PHQ‐9, in addition to duloxetine’s price, efficacy and toxicities.
In keeping with the researchers, including duloxetine just for sufferers who screened for despair led to an extra 17 QALYs per 1,000 sufferers, and elevated prices by $289 per affected person (ICER = $17,000 per QALY). In the meantime, common duloxetine, no matter screening, led to an extra 31 QALYs per 1,000 affected person and elevated prices by $1,205 per affected person (ICER = $39,300 per QALY). Based mostly on nearly all of their sensitivity analyses, the researchers concluded that common duloxetine was price‐efficient on the $100,000 per QALY threshold.
“Incorporating duloxetine’s twin efficacy for ache and depressive signs provides a greater understanding of duloxetine’s potential worth,” Lenhard and colleagues wrote. “Given the financial burden that despair and knee OA place on the well being care system and the prevalence of inadequately handled despair on this inhabitants, figuring out remedies that may tackle these points collectively is efficacious. This evaluation offers proof that, even with out screening for depressive signs, introducing duloxetine after NSAIDs fail to offer reduction in knee OA sufferers with average ache provides good worth as a ache administration choice.”