Cost-Effectiveness of Chondroitin Sulfate Plus Glucosamine Versus Celecoxib for Moderate To Severe Knee Osteoarthritis

OBJECTIVES: Knee Osteoarthritis (KOA) contributes to significant morbidity and healthcare expenditure in the United States. Nonsteroidal anti-inflammatory drug (NSAID) Celecoxib is frequently prescribed but carries notable gastrointestinal and cardiovascular risks. Non-FDA-approved supplements such as Chondroitin Sulfate plus Glucosamine (CS + GH) are favored by patients as alternatives to NSAIDs despite their debated efficacy and considerable out-of-pocket costs. This research aims to evaluate the cost-effectiveness of CS + GH compared to Celecoxib in treating moderate-to-severe KOA from a patient perspective in the United States.

METHODS: We employed a decision tree model (TreeAge Pro Healthcare 2023) over a 6-month horizon using data from the double-blind multicenter osteoarthritis intervention (MOVES) trial to compare CS + GH (400mg CS and 500mg GH thrice daily) against Celecoxib (200mg daily). All costs (converted to 2023 USD) were obtained from published literature (Redbook, Medical Expenditure Panel Survey (MEPS), American Journal of Managed Care (AJMC), GoodRx). Effectiveness was measured in Quality-Adjusted Life Years (QALYs) gained, with a willingness-to-pay (WTP) threshold of $150,000. One-way, two-way, and probabilistic sensitivity analyses were conducted. Key assumptions included a linear change in health utility, a 25% and 50% reduction in utility for those with serious adverse events and treatment non-responders respectively.

RESULTS: In base case analysis, QALYs gained per patient was higher for Celecoxib (0.04) compared to CS + GH (0.03). CS + GH had a lower expected cost per patient ($1,348) compared to Celecoxib ($1,550). Celecoxib was the more cost-effective option with an ICER of $32,408/QALY gained. Base case results were robust over a wide range of sensitivity analyses.

CONCLUSIONS: From the patients’ perspective, Celecoxib is likely more cost-effective compared to CS + GH for short-term management of moderate to severe KOA. However, this limitation encompassed the brief six-month study period, which may not reflect long-term outcomes.