The following is a summary of the “Does gabapentin provide benefit for patients with knee OA? A benefit-harm and cost-effectiveness analysis,” published in the February 2023 issue of Osteoarthritis and Cartilage by Bensen, et al.

Prescriptions for gabapentin, which is effective against nociplastic pain and neuropathic pain syndromes, have been on the rise. Knee osteoarthritis (OA) patients sometimes experience both nociceptive and nociplastic pain. Adding gabapentin to treatment for knee OA was analyzed for its cost-effectiveness. Researchers compared the efficacy of gabapentin in treating knee OA using the Osteoarthritis Policy Model, a validated Monte Carlo simulation of the disease.  

The three groups are: universal gabapentin plus usual care (UG+UC-GS); targeted gabapentin (TG), which provides gabapentin plus usual care for those who screen positive for nociplastic pain on the modified PainDETECT questionnaire (mPD-Q) and usual care only for those who screen negative for nociplastic pain; and UC plus GS, TG, and mPD minus Q. (UG). Results included total QALYs gained, total lifetime medical costs, and incremental cost-effectiveness ratios (ICERs), all discounted at 3 percent per year. In addition, researchers gathered data for the model from a variety of sources, including scholarly articles and government databases, and performed sensitivity analyses by changing the values of key input parameters.

Since it resulted in lower costs and more QALYs, UC-GS triumphed over both gabapentin-containing strategies. Costs went up by $689 due to TG, and quality-adjusted life years (QALYs) were lowered by 0.012. The additional cost of UG was $1,868, and the quality-adjusted life lost was 0.036 QALY. The findings held up under realistic variations in experiment conditions. For TG strategies, increasing mPD minus Q specificity to 100% and decreasing AE rate to 0% was reported to have the lowest ICER of $53,000 divided by QALY. Gabapentin does not appear to be cost-effective for the treatment of osteoarthritis of the knee.