Cost‐Utility Analysis of High Molecular Weight Hyaluronic Acid for Knee Osteoarthritis in Everyday Clinical Care in Patients at a Working Age: An Economic Evaluation of a Randomized Clinical Trial

Hermans, Job; Reijman, Max; Goossens, Lucas; Verburg, Hennie; Bierma-Zeinstra, Sita M A; Koopmanschap, Marc

doi:10.1002/acr.23242

Cited by 19 publications

(29 citation statements)

References 43 publications

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“…The cost-effectiveness analysis was in favour of VS. 56 Another study conducted in individuals of productive age (between 18 and 65 years old) concluded that the addition of high-molecular weight hyaluronic acid to the routine OA treatment is cost-effective. 57 Finally, a study carried out with the top 5 brands of hyaluronic acid on the American market concluded that viscosupplementation with any of was more cost-effective compared to routine treatment. Thus, the panel was strongly in agreement that viscosupplementation generates cost reductions for the supplementary health system and is a cost-effective procedure.…”

Section: Resultsmentioning

confidence: 99%

Brazilian Consensus Statement on Viscosupplementation of the Knee (Cobravi)

et al. 2019

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Objective: The aim of this consensus statement on viscosupplementation is to serve as a reference document based on relevant literature and clinical experience in the treatment of knee osteoarthritis using an intra-articular injection of hyaluronic acid, covering key aspects such as clinical indications, effectiveness, and tolerability. Methods: A multidisciplinary panel including two sports medicine physicians, six orthopedists, four physiatrists, and two rheumatologists were selected based on their clinical and academic experience of viscosupplementation. Sixteen statements were prepared and discussed, after which a vote was held. Each member of the panel gave a score between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. Results: The panel reached a consensus on several issues. Specifically, the panel agreed that the best indication is for mild to moderate knee arthrosis; prior or concomitant use of intraarticular triamcinolone hexacetonide may optimize the effect of hyaluronic acid; viscosupplementation should not be performed as an isolated procedure but in conjunction with other rehabilitative and pharmacological measures; viscosupplementation has analgesic, anti-inflammatory, and chondroprotective effects; and viscosupplementation is cost-effective. Conclusion: This consensus statement provides clear information and guidance for both individuals and payers. Level of evidence V, Consensus statement.

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Section: Resultsmentioning

confidence: 99%

Brazilian Consensus Statement on Viscosupplementation of the Knee (Cobravi)

et al. 2019

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“…Previous literature has demonstrated the cost-benefits of IA-HA use in comparison to other treatment options; however, this study utilizes a real-world evidence approach to evaluate all recorded health KOA-related costs rather than employing modeling methods to derive costs. [15][16][17][18][19][20][21] The direct evaluation of KOA-related costs within a national database provides a more representative assessment of the costs associated with KOA and how those costs may differ when IA-HA is included in the disease management paradigm. From a value-perspective, the potential cost savings seen when IA-HA is utilized should be taken into consideration along with the efficacy and safety evidence for this treatment.…”

Section: Discussionmentioning

confidence: 99%

Delay to TKA and Costs Associated with Knee Osteoarthritis Care Using Intra-Articular Hyaluronic Acid: Analysis of an Administrative Database

Concoff¹,

Niazi

Farrokhyar

et al. 2021

Clin Med�Insights�Arthritis�Musculoskelet Disord

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Background: Total knee arthroplasty (TKA) is a surgical treatment for patients with knee osteoarthritis (KOA) that no longer experience symptom relief from non-operative or pharmacologic treatments. Non-operative KOA management aims to address patient symptoms and improve function, as well as forestall or mitigate the large costs associated with TKA. The primary objective of this study was to examine the relationship between intra-articular hyaluronic acid (IA-HA) treatment and delaying TKA in patients with KOA compared to patients not receiving IA-HA, as well as to identify differences in KOA-related costs incurred among patients who received or did not receive IA-HA. Methods: This was a retrospective analysis of an administrative claims database from October 1st, 2010 through September 30th, 2015. Kaplan–Meier survival analysis was conducted to determine the TKA-free survival of patients who received IA-HA, stratified by the number of injection courses received versus those who did not receive any IA-HA. Median KOA-related costs per year were calculated for 2 comparisons: (1) patients who received IA-HA versus patients who did not receive IA-HA, among patients who eventually had TKA, and (2) patients who received IA-HA versus patients who did not receive IA-HA, among patients who did not have TKA. Results: A total of 744 734 patients were included in the analysis. A delay to TKA was observed after IA-HA treatment for patients treated with IA-HA compared to those who did not receive IA-HA. At 1 year, the TKA-free survival was 85.8% (95% CI: 85.6%-86.0%) for patients who received IA-HA and 74.1% (95% CI: 74.0%-74.3%) for those who did not receive IA-HA. At 2 years, the TKA free survival was 70.8% (70.5%-71.1%) and 63.7% (63.5%-63.9%) in the 2 groups, respectively. Patients treated with multiple courses of IA-HA demonstrated an incremental increase in delay to TKA with more courses of IA-HA, suggesting that the risk of TKA over the study time period is reduced with additional IA-HA courses. The hazard ratio for the need of TKA was 0.85 (95% CI 0.84-0.86) for a single course and 0.27 (95% CI 0.25-0.28) for ⩾5 courses, both compared to the no IA-HA group. In patients that eventually had TKA, the median KOA-related costs were lower among those who received IA-HA before their TKA ($860.24, 95% CI: 446.65-1722.20), compared to those who did not receive IA-HA ($2659.49, 95% CI: 891.04-7480.38). For patients who did not have TKA, the median and interquartile range (IQR) KOA-related costs per year were similar for patients who received IA-HA compared with those who did not. Conclusion: These results demonstrate that within a large cohort of KOA patients, individuals who received multiple courses of IA-HA had a progressively greater delay to TKA compared to patients who did not receive IA-HA treatment. Also, for patients who progressed to TKA, IA-HA treatment was associated with a large reduction in KOA-related healthcare costs. Based on these results, multiple, repeat courses of IA-HA may be beneficial in substantially delaying TKA in KOA patients, as well as minimizing KOA-related healthcare costs.

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“…In line with OARSI and ESCEO guidelines the NOV considers HA a secondary course of treatment for knee OA, but is not recommended for individuals with hip or polyarticular OA [ 2 , 4 ]. A recent study of Hermans et al showed that intra-articular HA injections had a good effect for knee OA in Dutch patients of working age and suggested that the use of HA is cost-effective for the Dutch health care situation [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

Orthobiologics and hyaluronic acid usage in the Netherlands: an electronic survey of 265 orthopaedic surgeons and sports physicians

Graeff¹,

Bekerom²,

Meer

et al. 2021

J EXP ORTOP

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Purpose “Biologic therapies” in the field of orthopaedic surgery and sports medicine, so called orthobiologics, have been gaining significant interest from physicians and patients, with increasing usage over the recent years. The aim of this study is to (1) evaluate the usage of orthobiologics in the Netherlands, (2) to clarify the reasons for the use or non-use of orthobiologics, and (3) the most addressed disease for use of orthobiologics. Methods The authors created a 19-quenstion online survey comprised of both closed-ended and open-ended response questions in order to examine the use of and the indication for orthobiologics. The survey was sent to all the members of the Dutch Orthopaedic Association and Netherlands Association of Sports Medicine of which 15% responded. Results The majority of the 265 respondents (65%) did not treat patients with or refer patients for treatment with orthobiologics. The most important reasons for not using orthobiologics were the lack of scientific evidence, the lack of good experience, and the lack of insurance coverage. Of the physicians that used orthobiologics, the most used hyaluronic acid (76%) and platelet-rich plasma (27%). Orthobiologics were most used for knee osteoarthritis and medial or lateral epicondylitis. Conclusion Although some orthobiologic treatments might be effective and the research interest is growing, our study shows that the majority of orthopaedic and sport physician clinicians in the Netherlands still does not make use of orthobiologics as a treatment option, but almost a third of them is contemplating to start using orthobiologics. Level of evidence III.

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Cost‐Utility Analysis of High Molecular Weight Hyaluronic Acid for Knee Osteoarthritis in Everyday Clinical Care in Patients at a Working Age: An Economic Evaluation of a Randomized Clinical Trial

Cited by 19 publications

References 43 publications

Brazilian Consensus Statement on Viscosupplementation of the Knee (Cobravi)

Brazilian Consensus Statement on Viscosupplementation of the Knee (Cobravi)

Delay to TKA and Costs Associated with Knee Osteoarthritis Care Using Intra-Articular Hyaluronic Acid: Analysis of an Administrative Database

Orthobiologics and hyaluronic acid usage in the Netherlands: an electronic survey of 265 orthopaedic surgeons and sports physicians

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