Symptomatic knee osteoarthritis (OA) is highly prevalent, disabling and costly. Pain related to knee OA is the principal driver of disability associated with this condition and attendant costs. Management of OA-related pain includes pharmacologic, non-pharmacologic, and surgical modalities. Clinicians and policy makers face critical questions related to effective pain management for knee OA: What is the impact of prolonged opioid use on patients'well-being? How do comorbidities affect medication choices and outcomes? Could novel analgesics offer sustainable pain relief at lower toxicity than currently available therapies? How do we scale up exercise and weight loss interventions to enable these programs to reach the millions of patients who might benefit from them? What efforts are needed to ensure adequate adherence to these interventions over time? At what age and level of functional status is it optimal to perform total knee replacement (TKR)? We propose to address these and related questions using a validated computer simulation model of knee OA natural history and treatment outcomes. We evaluate the health and economic effects of three major modalities of pain management in persons with knee OA: 1) the challenge posed by the increasing long-term use of opioids and by the chronic use of traditional pharmacologic agents in patients with comorbidities, along with the opportunities posed by novel analgesic agents;2) the opportunities and costs associated with implementing, scaling up, and sustaining the benefits of exercise, weight loss, and behavioral interventions;and 3) the timing and sequencing of surgical options including unicompartmental and total knee replacement. We have assembled an expert multidisciplinary team of rheumatologists, orthopedists, epidemiologists, biostatisticians, decision analysts, and health economists to evaluate the """"""""Clinical impact and cost-effectiveness of pain management in knee OA."""""""" This proposal has the following three specific aims: 1. To examine the long-term clinical impact and cost-effectiveness of pharmacologic analgesic strategies for knee OA that employ approved and investigational agents. 2. To examine the clinical and economic consequences of strategies related to the delivery of non- pharmacologic management in persons affected by knee OA. 3. To evaluate the long-term clinical impact and cost-effectiveness of alternative knee replacement strategies in persons with knee OA. This project will guide clinicians and policy makers in their efforts to reduce pain and disability and improve quality of life for people with knee OA.

Public Health Relevance

Osteoarthritis (OA) affects over 27 million Americans and causes disabling pain. There are several unresolved questions regarding the use of medications, behavioral interventions and surgery to relieve the pain of knee OA. This project combines the analysis of large data from OA-related studies with a computer simulation model of the lifetime costs and health consequences of osteoarthritis to evaluate these critical questions regarding pain management in OA.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR064320-02
Application #
8654303
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Lester, Gayle E
Project Start
2013-05-01
Project End
2018-04-30
Budget Start
2014-05-01
Budget End
2015-04-30
Support Year
2
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
City
Boston
State
MA
Country
United States
Zip Code
02115
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Suter, Lisa G; Smith, Savannah R; Katz, Jeffrey N et al. (2017) Projecting Lifetime Risk of Symptomatic Knee Osteoarthritis and Total Knee Replacement in Individuals Sustaining a Complete Anterior Cruciate Ligament Tear in Early Adulthood. Arthritis Care Res (Hoboken) 69:201-208
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Losina, E; Michl, G; Collins, J E et al. (2016) Model-based evaluation of cost-effectiveness of nerve growth factor inhibitors in knee osteoarthritis: impact of drug cost, toxicity, and means of administration. Osteoarthritis Cartilage 24:776-85
Smith, S R; Deshpande, B R; Collins, J E et al. (2016) Comparative pain reduction of oral non-steroidal anti-inflammatory drugs and opioids for knee osteoarthritis: systematic analytic review. Osteoarthritis Cartilage 24:962-72
Michl, G L; Katz, J N; Losina, E (2016) Risk and risk perception of knee osteoarthritis in the US: a population-based study. Osteoarthritis Cartilage 24:593-6
Katz, J N; Smith, S R; Collins, J E et al. (2016) Cost-effectiveness of nonsteroidal anti-inflammatory drugs and opioids in the treatment of knee osteoarthritis in older patients with multiple comorbidities. Osteoarthritis Cartilage 24:409-18
Von Keudell, Arvind G; Thornhill, Thomas S; Katz, Jeffrey N et al. (2016) Mortality Risk Assessment of Total Knee Arthroplasty and Related Surgery After Percutaneous Coronary Intervention. Open Orthop J 10:706-716

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