Long-term clinical benefit and cost-effectiveness of an 8-week multimodal knee osteoarthritis management program incorporating intra-articular sodium hyaluronate (Hyalgan<font face="arial, sans-serif" color="#222222">^&reg;</font>) injections

Abstract

BackgroundGiven the poor long-term effectiveness of focused nonsurgical knee osteoarthritis (OA) treatments, alternative therapies are needed for patients who have unsuccessfully exhausted nonsurgical options.MethodsA telephone interview was conducted in patients who participated in a single 8-week multimodal knee OA treatment program (mean follow-up: 3.7 years, range: 2.7–4.9 years). The program consisted of five intra-articular knee injections of sodium hyaluronate (Hyalgan®), with each injection given 1 week apart, structured physical therapy, knee bracing, and patient education. Clinical outcomes included knee pain severity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscores, current medication use, and history of total knee arthroplasty. Base-case, subgroup, and sensitivity analyses were conducted to determine the incremental cost-effectiveness ratio (ICER) of the treatment program with comparisons made to historical literature controls undergoing usual care.ResultsA total of 218 patients (54%) provided long-term follow-up data. Knee pain severity decreased 60% and WOMAC subscores decreased 33%–42% compared to baseline (all p<0.001). Total knee arthroplasty was performed in 22.8% (81/356) of knees during followup. The treatment program was highly cost-effective compared to usual care with a base-case ICER of $6,000 per quality-adjusted life year (QALY). Results of subgroup analyses, one-way deterministic sensitivity analyses, and second-order probabilistic sensitivity analyses resulted in ICERs ranging from $3,996 to $10,493 per QALY. The percentage of simulations with an ICER below willingness-to-pay limits was 97.2%, 98.9%, and 99.4% for the $50,000, $100,000, and $150,000 per QALY thresholds, respectively.ConclusionParticipation in a single 8-week knee OA treatment program, which included one cycle of five intra-articular knee injections of sodium hyaluronate given at weekly intervals, is highly cost-effective and provides clinically meaningful reductions in patient symptoms that are maintained over 3.7 years mean follow-up.

Intra-articular Hyaluronic Acid for Osteoarthritis of the Knee in the United States: A Systematic Review of Economic Evaluations

“…All cost-effectiveness studies identified [40][41][42][43][44][45][46][47] are included in Table 4. Waddell et al 40 developed a cost-of-illness model to demonstrate potential savings associated with IAHA treatment in a managed care setting (Table 4).…”

A Comprehensive Review of Viscosupplementation in Osteoarthritis of the Knee

“…A 2017 retrospective questionnaire-based survey con-ducted by Miller et al found that a multimodal treatment approach-five weekly injections of Hyalgen, structured physical therapy, knee bracing, and patient education-resulted in a 60% reduction in WOMAC pain subscores and had an incremental cost-effectiveness ratio (ICER) of 6,000 per quality-adjusted life-year (QALY). 46 However, nuances in viscosupplement agent selection require additional investigation.…”

“…4,5 Knee OA, specifically, has doubled in prevalence since the mid-20th century, and has been estimated to have a lifetime direct per-person costs for symptomatic patients of $12,400. 6,7 OA has also been shown to substantially decrease quality of life, with studies estimating 86 million quality-adjusted life-years lost due to knee OA alone. 8…”

Intraarticular Hyaluronic Acid Preparations for Knee Osteoarthritis: Are Some Better Than Others?

“…49,50,55,56,58 However, one study reported more local transient pain and swelling with Hyalgan (47%) compared to placebo (22%), 52 and one study reported 3 suspected treatment-related events in the Hyalgan group only (n = 30 patients). 51 The literature search found 13 observational studies, [60][61][62][63][64][65][66][67][68][69][70][71][72][73] with sample sizes that ranged from 31 to 249 patients, that reported conflicting results. One retrospective analysis 72 compared risk of TKA in patients receiving IAHA using IMS Health's PharMetrics Plus Health Plan Claims Database (50,389 patients).…”