Cooled radiofrequency ablation of the genicular nerves for chronic pain due to osteoarthritis of the knee: a cost-effectiveness analysis based on trial data.
BACKGROUND
For patients with painful knee osteoarthritis, long-term symptomatic relief may improve quality of life. Cooled radiofrequency ablation (CRFA) has demonstrated significant improvements in pain, physical function and health-related quality of life compared with conservative therapy with intra-articular steroid (IAS) injections. This study aimed to establish the cost-effectiveness of CRFA compared with IAS for managing moderate to severe osteoarthritis-related knee pain, from the US Medicare system perspective.


METHODS
We conducted a cost-effectiveness analysis utilizing efficacy data (Oxford Knee Scores) from a randomized, crossover trial on CRFA (NCT02343003), which compared CRFA with IAS out to 6 and 12 months, and with IAS patients who subsequently crossed over to receive CRFA after 6 months. Outcomes included health benefits (quality-adjusted life-years [QALYs]), costs and cost-effectiveness (expressed as cost per QALY gained). QALYs were estimated by mapping Oxford Knee Scores to the EQ-5D generic utility measure using a validated algorithm. Secondary analyses explored differences in the settings of care and procedures used in-trial versus real-world clinical practice.


RESULTS
CRFA resulted in an incremental QALY gain of 0.091 at an incremental cost of $1711, equating to a cost of US$18,773 per QALY gained over a 6-month time horizon versus IAS. Over a 12-month time horizon, the incremental QALY gain was 0.229 at the same incremental cost, equating to a cost of US$7462 per QALY gained versus IAS. Real-world cost assumptions resulted in modest increases in the cost per QALY gained to a maximum of US$21,166 and US$8296 at 6 and 12 months, respectively. Sensitivity analyses demonstrated that findings were robust to variations in efficacy and cost parameters.


CONCLUSIONS
CRFA is a highly cost-effective treatment option for patients with osteoarthritis-related knee pain, compared with the US$100,000/QALY threshold typically used in the US.
['Desai|Mehul|M|http://orcid.org/0000-0001-6870-9436', 'Bentley|Anthony|A|', 'Keck|William A|WA|', 'Haag|Thomas|T|', 'Taylor|Rod S|RS|', 'Dakin|Helen|H|']
D018771:Arthralgia D059350:Chronic Pain D003362:Cost-Benefit Analysis D018592:Cross-Over Studies D003714:Denervation D005260:Female D005938:Glucocorticoids D017048:Health Care Costs D006801:Humans D007036:Hypothermia, Induced D007270:Injections, Intra-Articular D007719:Knee Joint D008297:Male D006278:Medicare D009407:Nerve Block D020370:Osteoarthritis, Knee D011446:Prospective Studies D019057:Quality-Adjusted Life Years D000078703:Radiofrequency Ablation D013997:Time Factors D016896:Treatment Outcome D014481:United States D055815:Young Adult
CRFA Intra-articular steroid Oxford knee score QALY Cost-utility analysis Economic analysis