Summary of the Economic Evaluation of Interventions for Musculoskeletal Conditions| Conditions and treatment options | Considered cost-effective in developed countries?a | Generally recommended for developing countries?b | References | Additional comments |
| Osteoporosis |
| Primary prevention |
| Physical activity | No | Yes (for low-cost interventions) | Katzmarzyk, Gledhill, and Shephard 2000; Geelhoed, Harris, and Prince 1994; Patrick and others 2001 | Based on consensus |
| Calcium plus vitamin D | Yes | Yes | Willis 2002 | |
| HRT | Yes | — | Geelhoed, Harris, and Prince 1994; Armstrong and others 2001; Kanis and others 2002 | |
| Raloxifene | No | No | Armstrong and others 2001; Kanis and others 2002 | Based on evidence |
| Secondary prevention |
| Screening | No | No | Norlund 1996 | |
| Calcium and calcium plus vitamin D | Yes | Yes | Kanis and others 2002 | |
| HRT | Yes | Yes | Fleurence, Torgerson, and Reid 2002; Kanis and others 2002 | Differences in life expectancy and incidence of OP will affect age at which recommended |
| Raloxifene | No | No | Kanis and others 2002 | |
| Calcitonin, alendronate, and biphosphonates | No | No | Coyle and others 2001; Kanis and others 2002 | |
| Fluoride | No | No | Kanis and others 2002 | |
| Alfacalcidol | No | No | Kanis and others 2002 | More randomized clinic trials needed |
| Osteoarthritis |
| Primary prevention | No evidence | Yes | | Based on consensus |
| Secondary prevention |
| Education program | No | Further research needed | Lord and others 1999 | |
| Exercise program | No evidence | Low-cost programs may be useful | Patrick and others 2001 | |
| Nonselective NSAIDs | No for nabumetone | | McCabe and others 1998 | |
| Gastroprotective agents | Yes, but several qualifiers | | Van Dieten and others 2000; Gabriel, Campion, and O'Fallon 1994 | |
| Synovial fluid replacement | Yes | No | Torrance and others 2002 | Different comparators, relative price |
| Tertiary interventions |
| Total hip arthroplasty | Yes | — | Chang, Pellissier, and Hazen 1996 | |
| Knee replacement | Yes | — | Segal and others 2004 | |
| Rheumatoid arthritis |
| Inpatient or outpatient | No evidence | — | | |
| Telephone help line | Yes | Yes | Nordstrom and others 1996; Hughes and others 2002 | With good communications and low levels of access to medical care |
| Disease-modifying antirheumatic drugs |
| Auranofin | Not effective | No | Thompson and others 1988 | |
| Cyclosporine, azathioprine, D-penicillamine | Equal efficacy; cyclosporine should be used after cheaper, more effective drugs | No | Anis and others 1996 | Cost, monitoring, and adverse events |
| Combination therapy | Yes, in some studies | Possibly | Verhoeven and others 1998 | |
| Biologics | No data | No | — | Need trials in developing countries, but current costs are prohibitive |
| Corticosteroids | Yes | Possibly | Bae and others 2003 | Side effects |
| Low back pain |
| Back schools | No evidence | No | Van Tulder 2003 | |
| Massage | Little evidence | Yes, if low cost | Furlan and others 2002 | |
| Early interventions | Yes | Yes | Gatchel and others 2003 | Depends on labor market conditions |
| Ankylosing spondylitis |
| Spa exercise | Yes, but ICERs were sensitive to indirect costs | No | Van Tubergen and others 2002 | Does not provide compelling evidence |
| Biologics | No | No | — | Unattractive because of their high price |
Source: Authors.
a. Based on a cost-effectiveness threshold value of approximately US$30,000 or other favorable quantitative data on costs and benefits.
b. Based on authors' judgment of generally favorable/unfavorable cost-effectiveness evidence. See text for precise cost-effectiveness (for example, cost per QALY) data.
