Cost-Effectiveness of Chondroitin Sulphate (with or without Glucosamine) Prescription in the Treatment of Knee Osteoarthritis Compared to NSAIDs and COXIBs

Carlos Rubio-Terrés,1 Miguel Bernad Pineda,2 Josep Vergés3 1Health Economics Department, Health Value, Madrid, Spain; 2Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain; 3CEO Department, Osteoarthritis Foundation International (OAFI), Barcelona, SpainCorrespondence: Carlos Rubio-Terrés, Health Economics Department, Health Value, C/ Virgen de Aránzazu, 21, Madrid, 28034, Spain, Email [email protected]: Chondroitin sulfate, alone or associated with glucosamine (CS/CS+GLU), is an effective knee osteoarthritis (KOA) treatment, with fewer adverse effects (AEs) than non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase 2 inhibitors (COXIBs).Purpose: To estimate the CS/CS+GLU cost-effectiveness versus NSAIDs/COXIBs, due to the avoidance of mild-moderate or severe gastrointestinal AEs (GIAE), ischemic heart disease (IHD), acute kidney insufficiency (AKI), chronic kidney failure (CKF) and ischemic stroke (IS) from the Spanish National Health System (NHS) perspective.Methods: Two analyses were considered: 1) savings to the NHS from current CS/CS+GLU treatment; and 2) maximum savings that could be achieved by the NHS if all patients with KOA currently treated with NSAIDs/COXIB would be switched to CS/CS+GLU. AEs frequency, associated utilities loss and managing cost were obtained from medical literature and Spanish sources. A probabilistic model (second-order Monte Carlo simulation) was carried out for a 3-year time horizon. Treatment duration: 180 days (base case); 90 and 240 days (sensitivity analysis).Results: First analysis: 45,087 mild-moderate GIAE, 3,217 severe GIAE, 211 IHD, 1,087 AKI, 746 CKF and 3,359 IS, would be avoided with CS/CS+GLU. Discounting drugs cost, the three-year savings would be 57.1 million euros (savings probability: 80.7%). The savings per patient treated with CS/CS+GLU would amount to € 38.02 (95% CI 14.06; € 75.69), with a mean gain of 0.0023 (95% CI 0.0018– 0.0027) QALY. The probability that CS/CS+GLU treatment was dominant (lower costs and QALY gain) or cost-effective (cost per QALY gained less than € 25,000) was 80.7% and 98.1%, respectively. In the second analysis, savings for the NHS would amount to 387 million euros, with the CS/CS+GLU-only option being dominant and cost-effective in 100% of the analyses.Conclusion: The improved tolerability of CS/CS+GLU versus NSAIDs/COXIBs is expected to prevent thousands of AEs and generate considerable savings for the NHS, making it cost-effective treatment.Keywords: knee osteoarthritis, chondroitin sulfate, glucosamine, cost-effectiveness, budgetary impact, health impact