Cost-Effectiveness of Tramadol and Oxycodone in the Treatment of Knee Osteoarthritis

Savannah R. Smith, Jeffrey N. Katz, Jamie E. Collins, Daniel H. Solomon, Joanne M. Jordan, Lisa G. Suter, Edward H. Yelin, A. David Paltiel, Elena Losina

Research output: Contribution to journalArticle

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Abstract

Objective: To evaluate the cost-effectiveness of incorporating tramadol or oxycodone into knee osteoarthritis (OA) treatment. Methods: We used the Osteoarthritis Policy Model to evaluate long-term clinical and economic outcomes of knee OA patients with a mean age of 60 years with persistent pain despite conservative treatment. We evaluated 3 strategies: opioid-sparing (OS), tramadol (T), and tramadol followed by oxycodone (T+O). We obtained estimates of pain reduction and toxicity from published literature and annual costs for tramadol ($600) and oxycodone ($2,300) from Red Book Online. Based on published data, in the base case, we assumed a 10% reduction in total knee arthroplasty (TKA) effectiveness in opioid-based strategies. Outcomes included quality-adjusted life years (QALYs), lifetime cost, and incremental cost-effectiveness ratios (ICERs) and were discounted at 3% per year. Results: In the base case, T and T+O strategies delayed TKA by 7 and 9 years, respectively, and led to reduction in TKA utilization by 4% and 10%, respectively. Both opioid-based strategies increased cost and decreased QALYs compared to the OS strategy. Tramadol's ICER was highly sensitive to its effect on TKA outcomes. Reduction in TKA effectiveness by 5% (compared to base case 10%) resulted in an ICER for the T strategy of $110,600 per QALY; with no reduction in TKA effectiveness, the ICER was $26,900 per QALY. When TKA was not considered a treatment option, the ICER for T was $39,600 per QALY. Conclusion: Opioids do not appear to be cost-effective in OA patients without comorbidities, principally because of their negative impact on pain relief after TKA. The influence of opioids on TKA outcomes should be a research priority.

LanguageEnglish (US)
Pages234-242
Number of pages9
JournalArthritis Care and Research
Volume69
Issue number2
DOIs
StatePublished - Feb 1 2017

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Oxycodone
Tramadol
Knee Replacement Arthroplasties
Knee Osteoarthritis
Cost-Benefit Analysis
Quality-Adjusted Life Years
Opioid Analgesics
Costs and Cost Analysis
Therapeutics
Pain
Osteoarthritis
Comorbidity
Economics

ASJC Scopus subject areas

  • Rheumatology

Cite this

Smith, S. R., Katz, J. N., Collins, J. E., Solomon, D. H., Jordan, J. M., Suter, L. G., ... Losina, E. (2017). Cost-Effectiveness of Tramadol and Oxycodone in the Treatment of Knee Osteoarthritis. Arthritis Care and Research, 69(2), 234-242. DOI: 10.1002/acr.22916

Cost-Effectiveness of Tramadol and Oxycodone in the Treatment of Knee Osteoarthritis. / Smith, Savannah R.; Katz, Jeffrey N.; Collins, Jamie E.; Solomon, Daniel H.; Jordan, Joanne M.; Suter, Lisa G.; Yelin, Edward H.; David Paltiel, A.; Losina, Elena.

In: Arthritis Care and Research, Vol. 69, No. 2, 01.02.2017, p. 234-242.

Research output: Contribution to journalArticle

Smith, SR, Katz, JN, Collins, JE, Solomon, DH, Jordan, JM, Suter, LG, Yelin, EH, David Paltiel, A & Losina, E 2017, 'Cost-Effectiveness of Tramadol and Oxycodone in the Treatment of Knee Osteoarthritis' Arthritis Care and Research, vol. 69, no. 2, pp. 234-242. DOI: 10.1002/acr.22916
Smith SR, Katz JN, Collins JE, Solomon DH, Jordan JM, Suter LG et al. Cost-Effectiveness of Tramadol and Oxycodone in the Treatment of Knee Osteoarthritis. Arthritis Care and Research. 2017 Feb 1;69(2):234-242. Available from, DOI: 10.1002/acr.22916
Smith, Savannah R. ; Katz, Jeffrey N. ; Collins, Jamie E. ; Solomon, Daniel H. ; Jordan, Joanne M. ; Suter, Lisa G. ; Yelin, Edward H. ; David Paltiel, A. ; Losina, Elena. / Cost-Effectiveness of Tramadol and Oxycodone in the Treatment of Knee Osteoarthritis. In: Arthritis Care and Research. 2017 ; Vol. 69, No. 2. pp. 234-242
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abstract = "Objective: To evaluate the cost-effectiveness of incorporating tramadol or oxycodone into knee osteoarthritis (OA) treatment. Methods: We used the Osteoarthritis Policy Model to evaluate long-term clinical and economic outcomes of knee OA patients with a mean age of 60 years with persistent pain despite conservative treatment. We evaluated 3 strategies: opioid-sparing (OS), tramadol (T), and tramadol followed by oxycodone (T+O). We obtained estimates of pain reduction and toxicity from published literature and annual costs for tramadol ($600) and oxycodone ($2,300) from Red Book Online. Based on published data, in the base case, we assumed a 10{\%} reduction in total knee arthroplasty (TKA) effectiveness in opioid-based strategies. Outcomes included quality-adjusted life years (QALYs), lifetime cost, and incremental cost-effectiveness ratios (ICERs) and were discounted at 3{\%} per year. Results: In the base case, T and T+O strategies delayed TKA by 7 and 9 years, respectively, and led to reduction in TKA utilization by 4{\%} and 10{\%}, respectively. Both opioid-based strategies increased cost and decreased QALYs compared to the OS strategy. Tramadol's ICER was highly sensitive to its effect on TKA outcomes. Reduction in TKA effectiveness by 5{\%} (compared to base case 10{\%}) resulted in an ICER for the T strategy of $110,600 per QALY; with no reduction in TKA effectiveness, the ICER was $26,900 per QALY. When TKA was not considered a treatment option, the ICER for T was $39,600 per QALY. Conclusion: Opioids do not appear to be cost-effective in OA patients without comorbidities, principally because of their negative impact on pain relief after TKA. The influence of opioids on TKA outcomes should be a research priority.",
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