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A systematic review of the evolution of health-economic evaluation models of osteoarthritis


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Zhao, T, Ahmad, H ORCID: 0000-0002-2580-9856, de Graaff, B ORCID: 0000-0003-0743-9561, Xia, Q, Winzenberg, T ORCID: 0000-0002-4112-3491, Aitken, D ORCID: 0000-0001-5685-7634 and Palmer, AJ ORCID: 0000-0002-9703-7891 2020 , 'A systematic review of the evolution of health-economic evaluation models of osteoarthritis' , Arthritis Care & Research , pp. 1-34 , doi: 10.1002/acr.24410.

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Objective: To comprehensively synthesise the evolution of health-economic evaluation models (HEEMs) of all OA interventions including preventions, core treatments, adjunct non-pharmacological interventions, pharmacological and surgical treatments.Methods: The literature was searched within health-economic/biomedical databases. Data extracted included: OA type, population characteristics, model setting/type/events, study perspective, comparators; and the reporting quality of the studies was assessed. The review protocol was registered at the International Prospective Register of Systematic Reviews (registration: CRD42018092937).Results: Eighty-eight studies were included. Pharmacological and surgical interventions were the focus in 51% and 44% studies, respectively. Twenty-four studies adopted a societal perspective (with increasing popularity after 2013), however most (63%) did not include indirect costs. Quality-adjusted life years (QALYs) was the most popular outcome measure since 2008. Markov models were used by 62% of studies, with increasing popularity since 2008. Until 2010, most studies used short-to-medium time horizons; subsequently a lifetime horizon became popular. Eighty-six percent of studies reported discount rate(s) (predominantly between 3% and 5%). Studies published after 2002 had a better coverage of OA-related adverse events (AEs). Reporting quality significantly improved after 2001.Conclusions: OA HEEMs have evolved and improved substantially over time, with focus shifting from short-to-medium-term pharmacological decision-tree models to surgical-focused lifetime Markov models. Indirect costs of OA are frequently not considered, despite using a societal perspective. There was lack of reporting sensitivity of model outcome to input parameters including discount rate, OA definition, and population parameters. Whilst the coverage of OA-related AEs has improved over time, it is still not comprehensive.

Item Type: Article
Authors/Creators:Zhao, T and Ahmad, H and de Graaff, B and Xia, Q and Winzenberg, T and Aitken, D and Palmer, AJ
Keywords: systematic review, health economic models, osteoarthritis, health-economic evaluation, Markov models, decision-tree models
Journal or Publication Title: Arthritis Care & Research
Publisher: John Wiley & Sons, Inc.
ISSN: 2151-464X
DOI / ID Number: 10.1002/acr.24410
Copyright Information:

"This is the peer reviewed version of the following article: A Systematic Review of the Evolution of Health‐Economic Evaluation Models of Osteoarthritis, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions."

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