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Does gabapentin provide benefit for patients with knee OA? A benefit-harm and cost-effectiveness analysis

  • Gordon P. Bensen
    Affiliations
    Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Harvard Medical School, Boston, MA, USA
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  • Alec C. Rogers
    Affiliations
    Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
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  • Valia P. Leifer
    Affiliations
    Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
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  • Robert R. Edwards
    Affiliations
    Department of Anesthesiology, Brigham and Women’s Hospital, Boston, MA, USA
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  • Tuhina Neogi
    Affiliations
    Boston University School of Medicine, Boston, MA, USA
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  • Aleksandra M. Kostic
    Affiliations
    Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
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  • A. David Paltiel
    Affiliations
    Public Health Modeling Unit, Yale School of Public Health, New Haven, CT, USA
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  • Jamie E. Collins
    Affiliations
    Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Harvard Medical School, Boston, MA, USA
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  • David J. Hunter
    Affiliations
    Institute of Bone and Joint Research, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
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  • Jeffrey N. Katz
    Affiliations
    Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Harvard Medical School, Boston, MA, USA

    Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Boston, MA, USA

    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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  • Elena Losina
    Correspondence
    Corresponding author. Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, 75 Francis Street, BTM 5016, Boston, MA 02115. Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA Tel.: +(617) 732 5338; fax: +(617) 525 7900.
    Affiliations
    Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Harvard Medical School, Boston, MA, USA

    Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Boston, MA, USA

    Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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Published:November 19, 2022DOI:https://doi.org/10.1016/j.joca.2022.07.013

      Abstract

      Objective

      Gabapentin can treat neuropathic pain syndromes and has increasingly been prescribed to treat nociplastic pain. Some patients with knee osteoarthritis (OA) suffer from both nociceptive and nociplastic pain. We examined the cost-effectiveness of adding gabapentin to knee OA care.

      Method

      We used the Osteoarthritis Policy Model, a validated Monte Carlo simulation of knee OA, to examine the value of gabapentin in treating knee OA by comparing three strategies: 1) usual care, gabapentin sparing (UC-GS); 2) targeted gabapentin (TG), which provides gabapentin plus usual care for those who screen positive for nociplastic pain on the modified PainDETECT questionnaire (mPD-Q) and usual care only for those who screen negative; and 3) universal gabapentin plus usual care (UG). Outcomes included cumulative quality-adjusted life years (QALYs), lifetime direct medical costs, and incremental cost-effectiveness ratios (ICERs), discounted at 3% annually. We derived model inputs from published literature and national databases and varied key input parameters in sensitivity analyses.

      Results

      UC-GS dominated both gabapentin-containing strategies, as it led to lower costs and more QALYs. TG resulted in a cost increase of $689 and a cumulative QALY reduction of 0.012 QALYs. UG resulted in a further $1,868 cost increase and 0.036 QALY decrease. The results were robust to plausible changes in input parameters. The lowest TG strategy ICER of $53,000/QALY was reported when mPD-Q specificity was increased to 100% and AE rate was reduced to 0%.

      Conclusion

      Incorporating gabapentin into care for patients with knee OA does not appear to offer good value.

      Keywords

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