INTRODUCTION: In a previously published randomised, placebo-controlled trial, 800 mg/day of pharmaceutical-grade chondroitin sulfate (CS) was shown to be superior to placebo in reducing pain and improving function over 6 months in patients with symptomatic knee osteoarthritis (OA). The aim of the current post hoc analyses was to evaluate the cost-effectiveness of CS compared with placebo in a European perspective using individual patient data from this clinical trial. METHODS: Patients with knee OA randomised to CS or placebo were followed up at 1, 3 and 6 months. The algo-functional Lequesne index was used to derive the EuroQol Five-Dimension Five-Level (EQ-5D-5L) score based on a validated formula. The EQ-5D-5L scores at each time point were used to calculate the changes in quality-adjusted life years (QALYs) with the area under the curve method. Costs were assessed using the average price of CS in the countries where the original study took place and where CS is currently marketed. The costs of CS in three countries were then used (i.e. the Czech Republic, Italy and Switzerland). The incremental cost-effectiveness ratio (ICER) threshold for CS to be considered cost-effective was set at 91,870 EUR per QALY (equivalent to the usually recommended threshold of US $100,000). The study used an intention-to-treat population, i.e. patients who received one dose of the study drug, and imputed missing values using the basal observation carried forward method. RESULTS: No significant differences in baseline characteristics were observed between the CS group (N = 199) and the placebo group (N = 205). The mean cost of CS for 6 months of treatment was 194.74 EUR. After 6 months of treatment, CS showed a mean ICER of 33,462 (95% CI 5130-61,794) EUR per QALY gained, indicating cost-effectiveness compared with placebo. The acceptability curve for cost-effectiveness shows that the CS treatment is likely to be cost-effective compared with placebo, with a 93% probability when the ceiling ratio is set at 91,870 EUR per QALY gained. CONCLUSIONS: These results highlight the role of CS as a cost-effective therapeutic option in the management of OA. However, further studies taking into account the use of other healthcare resources are warranted for a more complete understanding.

Biochemistry Department College of Science King Saud University Riyadh Kingdom of Saudi Arabia

Department of Physical Activity and Rehabilitation Sciences University of Liège Liège Belgium

Research Unit in Public Health Epidemiology and Health Economics University of Liège CHU of Liege Bât B23 4000 Liège Belgium

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GBD 2021 Osteoarthritis Collaborators. Global, regional, and national burden of osteoarthritis, 1990–2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(9):e508–e522. 10.1016/s2665-9913(23)00163-7. PubMed PMC

Gibbs AJ, Gray B, Wallis JA, et al. Recommendations for the management of hip and knee osteoarthritis: a systematic review of clinical practice guidelines. Osteoarthritis Cartil. 2023;31(10):1280–92. 10.1016/j.joca.2023.05.015. PubMed

Bruyère O, Honvo G, Veronese N, et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum. 2019;49(3):337–50. 10.1016/j.semarthrit.2019.04.008. PubMed

Brito R, Costa D, Dias C, Cruz P, Barros P. Chondroitin sulfate supplements for osteoarthritis: a critical review. Cureus. 2023;15(6):e40192. 10.7759/cureus.40192. PubMed PMC

Reginster JY, Dudler J, Blicharski T, Pavelka K. Pharmaceutical-grade chondroitin sulfate is as effective as celecoxib and superior to placebo in symptomatic knee osteoarthritis: the ChONdroitin versus CElecoxib versus Placebo Trial (CONCEPT). Ann Rheum Dis. 2017;76(9):1537–43. 10.1136/annrheumdis-2016-210860. PubMed PMC

Kaplan RM, Babad YM. Balancing influence between actors in healthcare decision making. BMC Health Serv Res. 2011;11:85. 10.1186/1472-6963-11-85. PubMed PMC

Radinmanesh M, Ebadifard Azar F, Aghaei Hashjin A, Najafi B, Majdzadeh R. A review of appropriate indicators for need-based financial resource allocation in health systems. BMC Health Serv Res. 2021;21(1):674. 10.1186/s12913-021-06522-0. PubMed PMC

Dardenne N, Donneau A-F, Bruyère O. Mapping the Lequesne functional index into the EQ-5D-5L Utility index in patients with knee osteoarthritis. Value Health. 2024;27(10):1400–1407. PubMed

Cameron D, Ubels J, Norström F. On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review. Glob Health Action. 2018;11(1):1447828. 10.1080/16549716.2018.1447828. PubMed PMC

Bruyère O, Scholtissen S, Neuprez A, Hiligsmann M, Toukouki A, Reginster JY. Impact of chondroitin sulphate on health utility in patients with knee osteoarthritis: towards economic analysis. J Med Econ. 2009;12(4):356–60. 10.3111/13696990903438617. PubMed

Honvo G, Reginster JY, Rabenda V, et al. Safety of symptomatic slow-acting drugs for osteoarthritis: outcomes of a systematic review and meta-analysis. Drugs Aging. 2019;36(Suppl 1):65–99. 10.1007/s40266-019-00662-z. PubMed PMC

Hiligsmann M, Cooper C, Arden N, et al. Health economics in the field of osteoarthritis: an expert’s consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum. 2013;43(3):303–13. 10.1016/j.semarthrit.2013.07.003. PubMed