Cooled radiofrequency ablation of the genicular nerves for chronic pain due to osteoarthritis of the knee: a cost-effectiveness analysis based on trial data

Mehul Desai,William A Keck,Thomas Haag,Helen Dakin,Rod S Taylor,Anthony Bentley

doi:10.1186/s12891-019-2681-2

Abstract

BackgroundFor 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.MethodsWe 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.ResultsCRFA 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.ConclusionsCRFA 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.

Highlights

For patients with painful knee osteoarthritis, long-term symptomatic relief may improve quality of life
The current study aimed to evaluate the costeffectiveness of Cooled radiofrequency ablation (CRFA) compared with intra-articular steroid (IAS) injection for moderate to severe pain due to knee osteoarthritis from the US Medicare system perspective, by way of a decision analysis model utilizing outcomes from clinical trial NCT02343003 and costs from routine practice
Primary analyses At a time-horizon of 6 months post-treatment, CRFA was associated with a 0.091 gain in Quality-adjusted life-year (QALY) and an incremental cost of US$1711 compared with IAS

Summary

Introduction

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. CooliefTM System (Avanos Medical, Alpharetta, GA, USA), the cooled form of radiofrequency ablation (CRFA), is an effective and safe long-term therapeutic option for managing pain and improving physical function and health-related quality of life in patients with knee osteoarthritis [13,14,15,16,17] and to date is the only radiofrequency treatment to be approved by the FDA for management of osteoarthritis knee pain..

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