A nationwide multicenter study of the cost effectiveness of five leading drugs for pharmacological management of cervicobrachial symptoms

Norimitsu Wakao; Takeo Furuya; Toshitaka Yoshii; Hideyuki Arima; Yu Yamato; Hiroaki Nakashima; Shiro Imagama; Yasuaki Imajo; Hiroshi Miyamoto; Gen Inoue; Masayuki Miyagi; Shunsuke Kanbara; Yoichi Iizuka; Hirotaka Chikuda; Kei Watanabe; Kazuyoshi Kobayashi; Mikito Tsushima; Masashi Miyazaki; Mitsuru Yagi; Satoshi Suzuki; Masahiko Takahata; Michio Hongo; Masao Koda; Keiji Nagata; Kanji Mori; Akinobu Suzuki; Takashi Kaito; Kenta Murotani; Naohisa Miyakoshi; Hiroshi Hashizume; Yukihiro Matsuyama; Mamoru Kawakami; Hirotaka Haro; Project Committee of the Japanese Society for Spine Surgery and Related Research (JSSR)

doi:10.1016/j.jos.2023.12.004

A nationwide multicenter study of the cost effectiveness of five leading drugs for pharmacological management of cervicobrachial symptoms

J Orthop Sci. 2023 Dec 26:S0949-2658(23)00334-2. doi: 10.1016/j.jos.2023.12.004. Online ahead of print.

Authors

Norimitsu Wakao¹, Takeo Furuya², Toshitaka Yoshii³, Hideyuki Arima⁴, Yu Yamato⁵, Hiroaki Nakashima⁶, Shiro Imagama⁷, Yasuaki Imajo⁸, Hiroshi Miyamoto⁹, Gen Inoue¹⁰, Masayuki Miyagi¹¹, Shunsuke Kanbara¹², Yoichi Iizuka¹³, Hirotaka Chikuda¹⁴, Kei Watanabe¹⁵, Kazuyoshi Kobayashi¹⁶, Mikito Tsushima¹⁷, Masashi Miyazaki¹⁸, Mitsuru Yagi¹⁹, Satoshi Suzuki²⁰, Masahiko Takahata²¹, Michio Hongo²², Masao Koda²³, Keiji Nagata²⁴, Kanji Mori²⁵, Akinobu Suzuki²⁶, Takashi Kaito²⁷, Kenta Murotani²⁸, Naohisa Miyakoshi²⁹, Hiroshi Hashizume³⁰, Yukihiro Matsuyama³¹, Mamoru Kawakami³², Hirotaka Haro³³; Project Committee of the Japanese Society for Spine Surgery and Related Research (JSSR)

Affiliations

¹ Departments of Orthopaedic Surgery, Aichi Medical University, Nagakute, Aichi, Japan. Electronic address: nwakao2009@yahoo.co.jp.
² Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: furuya-takeo@chiba-u.jp.
³ Section of Orthopaedic Surgery; and Spinal Surgery, Tokyo Medical and Dental University, Graduate School, Tokyo, Japan. Electronic address: yoshii.orth@tmd.ac.jp.
⁴ Department of Orthopaedic Surgery, Hamamatsu University, School of Medicine, Hamamatsu, Japan. Electronic address: arihidee@yahoo.co.jp.
⁵ Department of Orthopaedic Surgery, Hamamatsu University, School of Medicine, Hamamatsu, Japan. Electronic address: yamato@hama-med.ac.jp.
⁶ Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: hirospine@med.nagoya-u.ac.jp.
⁷ Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: imagama@med.nagoya-u.ac.jp.
⁸ Department of Orthopaedic Surgery, Tokuyama Central Hospital, Shunan, Japan. Electronic address: iyasuak0117@gmail.com.
⁹ Department of Orthopaedic Surgery, Kobe Rosai Hospital, Kobe, Japan. Electronic address: hiroshimiyamoto@hotmail.com.
¹⁰ Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Sagamihara, Japan. Electronic address: ginoue@kitasato-u.ac.jp.
¹¹ Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Sagamihara, Japan. Electronic address: masayuki008@aol.com.
¹² Department of Orthopaedic Surgery, Chubu Rosai Hospital, Nagoya, Japan. Electronic address: shunaly@live.jp.
¹³ Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan. Electronic address: yoiizuka@gunma-u.ac.jp.
¹⁴ Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan. Electronic address: chikudah@gmail.com.
¹⁵ Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan. Electronic address: keiwatanabe_39jp@live.jp.
¹⁶ Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan. Electronic address: k_koba1@f2.dion.ne.jp.
¹⁷ Department of Orthopaedic Surgery, Konan Kosei Hospital, Konan, Japan. Electronic address: meikeihan@hotmail.com.
¹⁸ Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan. Electronic address: masashim@oita-u.ac.jp.
¹⁹ Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan. Electronic address: yagiman@gmail.com.
²⁰ Department of Orthopaedic Surgery, Keio University, Tokyo, Japan. Electronic address: ssatosea@yahoo.co.jp.
²¹ Department of Orthopaedic Surgery, Hokkaido University, Graduate School of Medicine, Sapporo, Japan. Electronic address: takamasa@med.hokudai.ac.jp.
²² Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan. Electronic address: mhongo@doc.med.akita-u.ac.jp.
²³ Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan. Electronic address: masaokod@gmail.com.
²⁴ Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan. Electronic address: keiji_nagata@icloud.com.
²⁵ Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan. Electronic address: kanchi@belle.shiga-med.ac.jp.
²⁶ Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan. Electronic address: akinobuh7@gmail.com.
²⁷ Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan. Electronic address: takashikaito@gmail.com.
²⁸ Biostatistics Center, Kurume University, Kurume, Japan. Electronic address: kmurotani@med.kurume-u.ac.jp.
²⁹ Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan. Electronic address: miyakosh@doc.med.akita-u.ac.jp.
³⁰ Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan. Electronic address: hashizum@wakayama-med.ac.jp.
³¹ Department of Orthopaedic Surgery, Hamamatsu University, School of Medicine, Hamamatsu, Japan. Electronic address: spine-yu@hama-med.ac.jp.
³² Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan. Electronic address: kawakami@saiseikai-wakayama.jp.
³³ Department of Orthopaedic Surgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Kofu, Japan. Electronic address: haro@yamanashi.ac.jp.

PMID: 38151393
DOI: 10.1016/j.jos.2023.12.004

Abstract

Background: Cervicobrachial pain frequently affects the quality of life (QOL) of the general public and has a significant economic impact on the health care systems of various countries. There are a number of treatment options for this disease, including widely-used drug therapy, but the effectiveness of each option is indeterminate, and there have been no published cost-effectiveness analysis studies so far. This prospective observational study aimed to examine the cost-effectiveness of drug treatment for cervicobrachial symptoms.

Methods: A 6-month medication regimen for each of five frequently-prescribed drugs for cervicobrachial symptoms was administered to 322 patients at 24 centers in Japan. Outcome measures, including of the EuroQol Group 5D, Short Form-8, and Visual Analog Scale (VAS), were investigated at baseline and every month thereafter. Incremental cost-effectiveness ratios (ICERs) of the drug cost to quality-adjusted life years (QALYs) were calculated. A stratified analysis of patient characteristics was also performed to identify baseline factors potentially affecting cost-effectiveness.

Results: The ICER of entire drug treatment for cervicobrachial symptoms was 7,491,640 yen. Compared with the reference willingness-to-pay, the ICER was assumed to not be cost-effective. A certain number of QALYs were gained during the first 3 months after the treatment intervention, but almost no QALYs were gained during the following 3 months. Stratified analysis showed that cost-effectiveness was extremely low for patients with high baseline VAS and high QOL.

Conclusions: The available medications for cervicobrachial symptoms did not have excellent cost-effectiveness. Although a certain number of QALYs were gained during the first 3 months after medication, no QALYs were gained in the latter half of the study period, suggesting that it is not advisable to continue the medication needlessly.

Level of evidence: II, prospective cohort study.

Keywords: Cervicobrachial symptoms; Cost effectiveness; Drugs; ICER; QALY; QOL.