 |
|
|
 |
Evidence-Based Medicine Is Affordable: The Cost-Effectiveness of Current Compared with Optimal Treatment in Rheumatoid and Osteoarthritis
GAVIN ANDREWS, LEONARDO SIMONELLA, HELEN LAPSLEY, KRISTY SANDERSON, and LYN MARCH ABSTRACT. Method. Population burden was calculated for both diseases in the absence of any treatment as years lived with disability (YLD), ignoring the years of life lost. We then estimated the proportion of burden averted with current interventions, the proportion that could be averted with optimally implemented current evidence-based guidelines, and the direct treatment cost-effectiveness ratio in dollars per YLD averted for both treatment levels. Results. The majority of people with arthritis sought medical treatment. Current treatment for RA averted 26% of the burden, with a cost-effectiveness ratio of $19,000 per YLD averted. Optimal, evidence-based treatment would avert 48% of the burden, with a cost-effectiveness ratio of $12,000 per YLD averted. Current treatment of OA in Australia averted 27% of the burden, with a cost-effectiveness ratio of $25,000 per YLD averted. Optimal, evidence-based treatment would avert 39% of the burden, with an unchanged cost-effectiveness ratio of $25,000 per YLD averted. Conclusion. While the precise dollar costs in each country will differ, the relativities at this level of coverage should remain the same. There is no evidence that closing the gap between evidence and practice would result in a drop in efficiency. (First Release Mar 15, 2006; J Rheumatol 2006;33:671-80)
Key Indexing Terms: OSTEOARTHRITIS
From the World Health Organization Collaborating Centre for Evidence in Health Policy, School of Psychiatry, University of New South Wales (UNSW) at St. Vincent's Hospital, Sydney, Australia. Supported by the National Health and Medical Research Council of Australia (grant 222787). G. Andrews, MD, Scientia Professor, UNSW; L. Simonella, MPH, Research Staff, UNSW; H. Lapsley, MEcon, Visiting Professor, UNSW; K. Sanderson, PhD, Postdoctoral Research Fellow, School of Public Health, Queensland University of Technology, Brisbane; L. March, PhD, MD, Associate Professor of Medicine and Public Health, Institute of Bone and Joint Research, University of Sydney. Address reprint requests to Dr. G. Andrews, 299 Forbes Street, Darlinghurst, NSW, Australia 2010. E-mail: gavina@unsw.edu.au Accepted for publication September 20, 2005.
|
