The cost-effectiveness of guideline recommended treatments for osteoarthritis: A systematic review.

OBJECTIVE To critically appraise the literature on the cost-effectiveness of guideline recommended treatments for osteoarthritis (OA). DESIGN Electronic databases were searched for studies that provided incremental cost-effectiveness ratios (ICER) for treatments recommended by key international guidelines to manage OA in adults. Treatments were grouped as lifestyle and rehabilitative therapies, pharmacological, injection, or surgical. Primary outcome was ICERs, converted to 2023 US dollars for comparability across studies. Risk of bias was assessed using the Consensus on Health Economic Criteria (CHEC) checklist for trials and the Drummond checklist for modelling studies. Studies were deemed cost-effective based on established country-specific thresholds per quality-adjusted life-year. RESULTS There were 110 studies that included 33 lifestyle and rehabilitative therapies, 25 pharmacological, 11 injection and 42 surgical studies. Most studies (95%) were conducted in high-income countries. Time horizons varied from 8 weeks to lifetime. Risk of bias domains were frequently scored poorly related to cost methods. Overall, the cost-effectiveness of lifestyle and rehabilitative therapies and non-steroidal anti-inflammatory drugs (NSAIDs) was mixed. Hyaluronic acid injection was cost-effective in knee OA compared to placebo, usual care and paracetamol but not to corticosteroid injections and NSAIDs. Total hip or knee replacement was cost-effective compared to usual care or no surgery, with early access to replacement cost-effective compared to delaying surgery. CONCLUSIONS There were a diversity of analytical perspectives and clinical heterogeneity of interventions. Policymakers should consider their local context when deciding clinical care and resource allocation.