Does Gabapentin Provide Benefit for Patients with Knee OA? A Benefit-harm and Cost-effectiveness Analysis

Overview

Journal Osteoarthritis Cartilage

Specialties Orthopedics
Rheumatology

Date 2022 Nov 22

PMID 36414225

Authors

G P Bensen

A C Rogers

V P Leifer

R R Edwards

T Neogi

A M Kostic

A D Paltiel

J E Collins

D J Hunter

J N Katz

E Losina

Affiliations

Soon will be listed here.

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.

Citing Articles

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References

Neumann P, Cohen J, Weinstein M . Updating cost-effectiveness--the curious resilience of the $50,000-per-QALY threshold. N Engl J Med. 2014; 371(9):796-7. DOI: 10.1056/NEJMp1405158. View

Hochman J, Gagliese L, Davis A, Hawker G . Neuropathic pain symptoms in a community knee OA cohort. Osteoarthritis Cartilage. 2011; 19(6):647-54. DOI: 10.1016/j.joca.2011.03.007. View

Kolasinski S, Neogi T, Hochberg M, Oatis C, Guyatt G, Block J . 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). 2020; 72(2):149-162. PMC: 11488261. DOI: 10.1002/acr.24131. View

Bellows B, Nelson R, Oderda G, LaFleur J . Long-term cost-effectiveness of initiating treatment for painful diabetic neuropathy with pregabalin, duloxetine, gabapentin, or desipramine. Pain. 2015; 157(1):203-213. DOI: 10.1097/j.pain.0000000000000350. View

Tarride J, Gordon A, Vera-Llonch M, Dukes E, Rousseau C . Cost-effectiveness of pregabalin for the management of neuropathic pain associated with diabetic peripheral neuropathy and postherpetic neuralgia: a Canadian perspective. Clin Ther. 2007; 28(11):1922-34. DOI: 10.1016/j.clinthera.2006.11.017. View

Enteshari-Moghaddam A, Azami A, Isazadehfar K, Mohebbi H, Habibzadeh A, Jahanpanah P . Efficacy of duloxetine and gabapentin in pain reduction in patients with knee osteoarthritis. Clin Rheumatol. 2019; 38(10):2873-2880. DOI: 10.1007/s10067-019-04573-7. View

Appleyard T, Ashworth J, Bedson J, Yu D, Peat G . Trends in gabapentinoid prescribing in patients with osteoarthritis: a United Kingdom national cohort study in primary care. Osteoarthritis Cartilage. 2019; 27(10):1437-1444. DOI: 10.1016/j.joca.2019.06.008. View

Sullivan J, Huizinga J, Edwards R, Hunter D, Neogi T, Yelin E . Cost-effectiveness of duloxetine for knee OA subjects: the role of pain severity. Osteoarthritis Cartilage. 2020; 29(1):28-38. PMC: 7814698. DOI: 10.1016/j.joca.2020.10.001. View

Fu K, Robbins S, McDougall J . Osteoarthritis: the genesis of pain. Rheumatology (Oxford). 2017; 57(suppl_4):iv43-iv50. DOI: 10.1093/rheumatology/kex419. View

10.

OConnor A, Noyes K, Holloway R . A cost-utility comparison of four first-line medications in painful diabetic neuropathy. Pharmacoeconomics. 2008; 26(12):1045-64. DOI: 10.2165/0019053-200826120-00007. View

11.

Jorgensen T, Graven-Nielsen T, Ellegaard K, Danneskiold-Samsoe B, Bliddal H, Henriksen M . Intra-Articular Analgesia and Steroid Reduce Pain Sensitivity in Knee OA Patients: An Interventional Cohort Study. Pain Res Treat. 2014; 2014:710490. PMC: 4033499. DOI: 10.1155/2014/710490. View

12.

Losina E, Walensky R, Reichmann W, Holt H, Gerlovin H, Solomon D . Impact of obesity and knee osteoarthritis on morbidity and mortality in older Americans. Ann Intern Med. 2011; 154(4):217-26. PMC: 3260464. DOI: 10.7326/0003-4819-154-4-201102150-00001. View

13.

Neogi T . The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage. 2013; 21(9):1145-53. PMC: 3753584. DOI: 10.1016/j.joca.2013.03.018. View

14.

Zolio L, Lim K, McKenzie J, Yan M, Estee M, Hussain S . Systematic review and meta-analysis of the prevalence of neuropathic-like pain and/or pain sensitization in people with knee and hip osteoarthritis. Osteoarthritis Cartilage. 2021; 29(8):1096-1116. DOI: 10.1016/j.joca.2021.03.021. View

15.

Davari M, Amani B, Amani B, Khanijahani A, Akbarzadeh A, Shabestan R . Pregabalin and gabapentin in neuropathic pain management after spinal cord injury: a systematic review and meta-analysis. Korean J Pain. 2020; 33(1):3-12. PMC: 6944364. DOI: 10.3344/kjp.2020.33.1.3. View

16.

Wiffen P, Derry S, Bell R, Rice A, Tolle T, Phillips T . Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017; 6:CD007938. PMC: 6452908. DOI: 10.1002/14651858.CD007938.pub4. View

17.

Stanley E, Trentadue T, Smith K, Sullivan J, Thornhill T, Lange J . Cost-effectiveness of dental antibiotic prophylaxis in total knee arthroplasty recipients with type II diabetes mellitus. Osteoarthr Cartil Open. 2022; 2(4):100084. PMC: 9718342. DOI: 10.1016/j.ocarto.2020.100084. View

18.

Arant K, Katz J, Neogi T . Quantitative sensory testing: identifying pain characteristics in patients with osteoarthritis. Osteoarthritis Cartilage. 2021; 30(1):17-31. PMC: 8712382. DOI: 10.1016/j.joca.2021.09.011. View

19.

Felli J, Noel R, Cavazzoni P . A multiattribute model for evaluating the benefit-risk profiles of treatment alternatives. Med Decis Making. 2008; 29(1):104-15. DOI: 10.1177/0272989X08323299. View

20.

Lee M, Silverman S, Hansen H, Patel V, Manchikanti L . A comprehensive review of opioid-induced hyperalgesia. Pain Physician. 2011; 14(2):145-61. View