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Rheumatology Advance Access originally published online on May 29, 2008
Rheumatology 2008 47(7):1077-1081; doi:10.1093/rheumatology/ken128
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Cost–effectiveness of advising the use of topical or oral ibuprofen for knee pain; the TOIB study [ISRCTN: 79353052]

E. Castelnuovo1, P. Cross1, S. Mt-Isa2, A. Spencer3, M. Underwood on behalf of the TOIB study team4

1Centre for Health Sciences, 2Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, 3Department of Economics, Queen Mary University of London, London and 4Clinical Trials Unit, Warwick Medical School, Coventry, UK.

Correspondence to: M. Underwood, Clinical Trials Unit, Warwick Medical School, Gibbet Hill Road, Coventry CV4 7AL, UK. E-mail: m.underwood{at}warwick.ac.uk


  Abstract

Objective. Advice to use topical or oral NSAIDs is equally effective for the treatment of knee pain in older people. The ingredient cost of topical preparations is typically more than oral preparations, but could save costs because they have fewer adverse effects. A cost–utility study is needed to decide on their comparative cost effectiveness.

Methods. We recruited 585 people aged ≥50 yrs with knee pain; 282 participated in a randomized controlled trial and 303 in a patient preference study from 26 MRC General Practice Research Framework practices in the UK. They received advice to preferentially use topical or oral NSAIDs for knee pain. We calculated the comparative cost per quality-adjusted life year (QALY) from both a National Health Service (NHS) and a societal perspective over 12 and 24 months.

Results. Compared with the topical route, oral NSAIDs cost the NHS £191 and £72 more over 1 yr in the randomized trial and preference study, respectively. The cost per QALY, from an NHS perspective, was in the range of £9000–£12 000 in the randomized trial. In the preference study, it was £2564 over 1 yr, but over 2 yrs the oral route was dominant.

Conclusions. Our cost–effectiveness analysis supports the use of oral NSAIDs in selected patients. Nevertheless, deciding to recommend oral NSAIDs in preference to topical NSAIDs could have a substantial impact on NHS costs because of the uncertainty in the cost–effectiveness estimate.

KEY WORDS: Primary care, Knee pain, Osteoarthritis, Health economics, Non-steroidal anti-inflammatory drugs, Topical non-steroidal anti-inflammatory drugs

Submitted 9 November 2007; revised version accepted 26 February 2008.
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