Due to the growing worldwide prevalence of knee osteoarthritis, the optimal management of this issue is critical for reducing its burden.ObjectivesThis study aimed to describe patients treated for knee osteoarthritis between 2006 and 2013 in France and to compare the delay from diagnosis to total knee replacement between patients who received intra-articular hyaluronic acid injections and those who did not receive the injections. A second objective was to compare direct medical costs for ambulatory care between treatment groups.Materials and methodsPatients were selected from a representative sample of the real world administrative claims database using an algorithm developed by experts from the scientific committee of the study. Data were matched with the medico-administrative database for hospital care. A Cox proportional hazards model was stratified for the treatment group and adjusted for available socio-demographic and medical covariates to compare restricted mean survival times at different time points (1, 3, 5 and 7.5 years) between groups. Costs were expressed in 2013 euros.ResultsA total of 14,782 patients were treated for knee osteoarthritis (67% women; mean age = 68 years). Among this population, 1,662 patients had total knee replacement (11.2%). At each time point, restricted mean survival time without total knee replacement was significantly higher (p-values<0.001) for hyaluronic acid group, from +51 to +217 days at 1 and 7.5 years, respectively. For the year preceding total knee replacement, the means for total direct medical costs were similar between groups, €744 vs €805 for treatment and control groups, respectively, (p-value = 0.104). Intra-articular injections accounted for less than 10% of the total costs.ConclusionThis is the first retrospective longitudinal study involving knee osteoarthritis patients using medico-administrative databases in France. The results support the effectiveness of hyaluronic acid injections in delaying total knee replacement and show that patients treated with hyaluronic acid have similar direct medical costs for ambulatory care compared to patients treated with corticosteroids only.

A553all groups, costs increased gradually leading up to surgery and peaked in the month after surgery. Three years pre-surgery, mean monthly total cost was in the successful group: € 531; undetermined: € 882; persistent pain: € 891; and to-be SCS patients: € 1,153. Three years post-surgery, the corresponding cost was € 509, € 1,105, € 1,269 and € 3,346, respectively. The groups with persistent pain, undetermined outcome and to-be SCS patients had worse baseline QoL (0.26, 0.33, 0.20, respectively) and worse QoL post-surgery (0.46, 0.62, 0.24), compared with the successful group (baseline: 0.34, post-surgery 0.82). ConClusions: There was an apparent association between outcome, costs and post-surgery QoL. Patients with undetermined outcome, persistent pain and to-be-SCS patients had less QoL improvement post-surgery and higher costs both before and after surgery compared with the successful group.