A systematic literature review

Osteoarthritis (OA) is a chronic joint disease that leads to a loss of articular cartilage, resulting in painful bone-on-bone contact. Females have a higher risk of developing OA compared to males, and obese individuals are three times more likely to develop OA. Currently, the population at the highest risk for the development of OA are individuals 65 years and older. Incidence and prevalence rates are difficult to determine due diversity of diagnostic definitions (clinical vs radiographic), however, the estimated prevalence rates in Canada are between 10-14.2% of the population over 30 years of age. The eventual joint failure associated with OA progression greatly impacts overall joint function, mobility, and quality of life among patients with moderate-to-severe OA. Furthermore, individuals over 65 years of age are currently the fastest growing population, largely contributing to a rapid increase in OA prevalence over the next 10 years. Therefore, capturing the burden of disease in Canada is imperative for the development and implementation of effective treatment strategies.

The objective of this study was to identify available real-world evidence (RWE) on the clinical and economic burden of moderate-to-severe OA in Canada via systematic literature review (SLR).

For this study, Medlior and Pfizer Canada collaborated to construct search strategies that were executed in MEDLINE, Embase, and the Cochrane Library, in addition to selected conferences, to identify citations published between January 2013 and November 2018. Selection criteria included Canadian populations with clinically or radiographically confirmed moderate-to-severe OA, as defined by the author(s).

A total of 2,245 citations were identified by the electronic databases. After duplicates were removed, 1,910 citations underwent title/abstract screening, and 241 were determined eligible for full-text review. From the full-text review, 23 Canadian RWE citations met eligibility criteria, 19 of which were determined to be unique studies following the identification of companion publications (study mapping).

One of the primary outcomes of this SLR was the prevalence of OA in the Canadian population. Notably, population prevalence rates were not reported. However, one microsimulation model estimated that over 3.6 million Canadians were living with OA in 2010. Study population demographics/characteristics were predominantly female (44-83%), 57-74 years old, and had a mean BMI score >25 kg/m2.

Beyond key baseline patient characteristics, results were quite heterogeneous across the studies. Seven studies captured joint characteristics of individuals with moderate-to-severe OA of the hip or knee; only six studies reported pain scores utilizing a variety of assessment tools.

The main findings of the SLR highlighted that individuals with moderate-severe OA on average experience more than one symptomatic joint (3-6 joints; three studies), report hypertension as the most common comorbidity (61-68%; two studies), and that NSAIDs are the most frequently used treatment (range: 37-71%; two studies). Opioid use for pain management was an additional treatment of interest, however, opioid use was not consistently reported across the three studies that evaluated opioid use, thereby limiting synthesis of data.

Two studies reported on the economic burden of OA, one of which demonstrated that opioids are the most costly treatment option for OA, and that commonly used non-selective NSAIDs are the least expensive treatment option, but also the least effective. A microsimulation model estimated the average annual cost of OA per person increased with disease severity ($468 Stage 1 (OA diagnosis) to $3,185 Stage 4 (joint revision surgery); 2017 $CAD), with the highest costs for moderate-to-severe OA driven by surgical cost associated with joint replacement.

The burden of moderate-to-severe OA in Canada is significant. The current SLR identified 19 unique real-world studies of moderate-to-severe OA in Canada, however, inconsistency regarding standardized definitions and reporting highlight an important gap in prevention and treatment strategies. Additionally, although publications were restricted to the last five years, much of the data reported in these papers were over 10 years, and in some cases over 20 years, old. Despite limited ability for data synthesis, data from this SLR highlight that progressing disease and worsening disability leads to poor patient-outcomes and increased healthcare costs.

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