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


Zhao, T and Ahmad, H and de Graaff, B and Xia, Q and Winzenberg, T and Aitken, D and Palmer, AJ, A systematic review of the evolution of health-economic evaluation models of osteoarthritis, Arthritis Care & Research Article accepted manuscript. ISSN 2151-464X (2020) [Refereed Article]

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Copyright Statement

"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."

DOI: doi:10.1002/acr.24410


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 Details

Item Type:Refereed Article
Keywords:systematic review, health economic models, osteoarthritis, health-economic evaluation, Markov models, decision-tree models
Research Division:Economics
Research Group:Applied economics
Research Field:Health economics
Objective Division:Health
Objective Group:Public health (excl. specific population health)
Objective Field:Public health (excl. specific population health) not elsewhere classified
UTAS Author:Zhao, T (Dr Ting Zhao)
UTAS Author:Ahmad, H (Dr Hasnat Ahmad)
UTAS Author:de Graaff, B (Dr Barbara de Graaff)
UTAS Author:Xia, Q (Miss Qing Xia)
UTAS Author:Winzenberg, T (Professor Tania Winzenberg)
UTAS Author:Aitken, D (Associate Professor Dawn Aitken)
UTAS Author:Palmer, AJ (Professor Andrew Palmer)
ID Code:140329
Year Published:2020
Deposited By:Menzies Institute for Medical Research
Deposited On:2020-08-07
Last Modified:2021-05-19
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