Cost-Effectiveness of Treating Early to Moderate Stage Knee Osteoarthritis with Intra-articular Hyaluronic Acid Compared to Conservative Interventions

Jeffrey Rosen, Faizan Niazi, Stan Dysart, Jeffrey Rosen, Faizan Niazi, Stan Dysart

Abstract

Introduction: Evidence has demonstrated greater benefit of intra-articular hyaluronic acid (IA-HA) within earlier stages of knee osteoarthritis (OA) rather than waiting for patients to have progressed to later stages of disease progression. High molecular weight (HMW) HA has also been shown to be more effective than low molecular weight (LMW) HA products in mild to moderate knee OA, providing an important distinction to make within the class of IA-HA therapies. The purpose of this study is to evaluate the cost-effectiveness of treating patients with knee OA with HMW HA compared to LMW and conservative treatment, while taking into account disease stage.

Methods: Decision analytic models were created for early/moderate, as well as late stage knee OA. Models for late stage knee OA were created by assuming a range of response rates to IA-HA treatments from 10% to 50%. These models included conservative treatment using physical therapy/exercise, braces/orthosis, and medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics. The models compared the cost per quality adjusted life year (QALY) gained for these treatments to the use of either LMW or HMW HA. Incremental cost-effectiveness ratios (ICERs) were calculated for each treatment in relation to HMW HA.

Results: When evaluating treatment in early to moderate knee OA, HMW HA was dominant over LMW HA and physical therapy/exercise, as it was less expensive and provided greater benefit. HMW HA was cost-effective versus braces/orthosis and NSAID/analgesic medications based on a willingness to pay threshold of $50,000. In the model of 50% response rate to IA-HA for late stage OA, HMW HA remained cost-effective in comparison to physical therapy/exercise and braces/orthosis at a willingness to pay threshold of $50,000; but not NSAID/analgesic medications. In the worst-case scenario of a 10% responder rate to IA-HA, HMW HA was no longer cost-effective in any circumstance.

Conclusion: IA-HA, particularly HMW formulations, demonstrate cost-effectiveness when compared to conservative treatment options and LMW HA in patients with early/mid stage knee OA. The cost-effectiveness of HMW HA in patients with later stage knee OA was not as apparent, particularly because of the uncertainty in the proportion of patients with late stage OA who have a meaningful improvement after receiving IA-HA. This cost-effectiveness finding supports the use of IA-HA in patients with early and moderate knee OA, as the benefits of IA-HA are apparent within the patient population with mild to moderate knee OA. The findings of this study suggest that there is a potential cost savings benefit as a result of utilizing HMW HA in earlier stages of knee OA as opposed to later stages.

Funding: Ferring Pharmaceuticals Inc.

Keywords: Cost analysis; Cost-effectiveness; Hyaluronic acid; Knee; Osteoarthritis; Rheumatology.

Figures

Fig. 1
Fig. 1
Tree diagram for early/mid knee OA

References

    1. Haq I, Murphy E, Dacre J. Osteoarthritis. Postgrad Med J. 2003;79(933):377–383. doi: 10.1136/pmj.79.933.377.
    1. Laupattarakasem W, Laopaiboon M, Laupattarakasem P, Sumananont C. Arthroscopic debridement for knee osteoarthritis. Cochrane Database Syst Rev. 2008(1):CD005118.
    1. Vos T, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2163–2196. doi: 10.1016/S0140-6736(12)61729-2.
    1. Holt HL, et al. Forecasting the burden of advanced knee osteoarthritis over a 10-year period in a cohort of 60–64 year-old US adults. Osteoarthr Cartil. 2011;19(1):44–50. doi: 10.1016/j.joca.2010.10.009.
    1. Wallace IJ, et al. Knee osteoarthritis has doubled in prevalence since the mid-20th century. Proc Natl Acad Sci USA. 2017;114(35):9332–9336. doi: 10.1073/pnas.1703856114.
    1. Losina E, et al. Lifetime medical costs of knee osteoarthritis management in the United States: impact of extending indications for total knee arthroplasty. Arthritis Care Res (Hoboken) 2015;67(2):203–215. doi: 10.1002/acr.22412.
    1. Madry H, et al. Early osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1753–1762. doi: 10.1007/s00167-016-4068-3.
    1. Rosen J, et al. Clinicians’ perspectives on the use of intra-articular hyaluronic acid as a treatment for knee osteoarthritis: a North American, multidisciplinary survey. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:21–27. doi: 10.4137/CMAMD.S34496.
    1. Altman Roy D., Schemitsch Emil, Bedi Asheesh. Assessment of clinical practice guideline methodology for the treatment of knee osteoarthritis with intra-articular hyaluronic acid. Seminars in Arthritis and Rheumatism. 2015;45(2):132–139. doi: 10.1016/j.semarthrit.2015.04.013.
    1. Zhang Y, et al. Using patient values and preferences to inform the importance of health outcomes in practice guideline development following the GRADE approach. Health Qual Life Outcomes. 2017;15(1):52. doi: 10.1186/s12955-017-0621-0.
    1. Grazina R, et al. Clinical management in early OA. Adv Exp Med Biol. 2018;1059:111–135. doi: 10.1007/978-3-319-76735-2_5.
    1. Filardo G, et al. Non-surgical treatments for the management of early osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2016;24(6):1775–1785. doi: 10.1007/s00167-016-4089-y.
    1. Jevsevar DS. Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg. 2013;21(9):571–6.
    1. Ong C.K.S., Lirk P., Tan C.H., Seymour R.A. An Evidence-Based Update on Nonsteroidal Anti-Inflammatory Drugs. Clinical Medicine & Research. 2007;5(1):19–34. doi: 10.3121/cmr.2007.698.
    1. Jevsevar DS, et al. Mixed treatment comparisons for nonsurgical treatment of knee osteoarthritis: a network meta-analysis. J Am Acad Orthop Surg. 2018;26(9):325–336. doi: 10.5435/JAAOS-D-17-00318.
    1. Bannuru RR, et al. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. 2015;162(1):46–54. doi: 10.7326/M14-1231.
    1. Altman RD, et al. Product differences in intra-articular hyaluronic acids for osteoarthritis of the knee. Am J Sports Med. 2016;44(8):2158–2165. doi: 10.1177/0363546515609599.
    1. Altman Roy D., Farrokhyar Forough, Fierlinger Anke, Niazi Faizan, Rosen Jeffrey. Analysis for Prognostic Factors from a Database for the Intra-Articular Hyaluronic Acid (Euflexxa) Treatment for Osteoarthritis of the Knee. CARTILAGE. 2015;7(3):229–237. doi: 10.1177/1947603515620890.
    1. Nicholls Mathew, Shaw Peter, Niazi Faizan, Bhandari Mohit, Bedi Asheesh. The Impact of Excluding Patients with End-Stage Knee Disease in Intra-Articular Hyaluronic Acid Trials: A Systematic Review and Meta-Analysis. Advances in Therapy. 2018;36(1):147–161. doi: 10.1007/s12325-018-0847-1.
    1. Hatoum HT, et al. Cost-effectiveness analysis of intra-articular injections of a high molecular weight bioengineered hyaluronic acid for the treatment of osteoarthritis knee pain. J Med Econ. 2014;17(5):326–337. doi: 10.3111/13696998.2014.902843.
    1. Rosen J, et al. Cost-effectiveness of different forms of intra-articular injections for the treatment of osteoarthritis of the knee. Adv Ther. 2016;33(6):998–1011. doi: 10.1007/s12325-016-0331-8.
    1. Philips Z, et al. Review of guidelines for good practice in decision-analytic modelling in health technology assessment. Health Technol Assess. 2004;8(36):iii–iv, ix–xi, 1–158.
    1. Simoens S. Health economic assessment: a methodological primer. Int J Environ Res Public Health. 2009;6(12):2950–2966. doi: 10.3390/ijerph6122950.

Source: PubMed

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