Knee OA cost comparison for hyaluronic acid and knee arthroplasty

Abstract

Background: Limiting treatment to those recommended by the American Academy of Orthopaedic Surgeon Clinical Practice Guidelines has been suggested to decrease costs by 45% in the year prior to total knee arthroplasty, but this only focuses on expenditures leading up to, but not including, the surgery and not the entire episode of care. We evaluated the treatment costs following knee osteoarthritis (OA) diagnosis and determined whether these are different for patients who use intra-articular hyaluronic acid (HA) and/or knee arthroplasty. Methods: Claims data from a large commercial database containing de-identified data of more than 100 million patients with continuous coverage from 2012 to 2016 was used to evaluate the cumulative cost of care for over 2 million de-identified members with knee OA over a 4.5-year period between 2011 and 2015. Median cumulative costs were then stratified for patients with or without HA and/or knee arthroplasty. Results: Knee OA treatment costs for 1,567,024 patients over the 4.5-year period was $6.60 billion (mean $4210/ patient) as calculated by the authors. HA and knee arthroplasty accounted for 3.0 and 61.5% of the overall costs, respectively. For patients who underwent knee arthroplasty, a spike in median costs occurred sooner for patients without HA use (around the 5-to 6-month time point) compared to patients treated with HA (around the 16-to 17-month time point). Conclusions: Non-arthroplasty therapies, as calculated by the authors, accounted for about one third of the costs in treating knee OA in our cohort. Although some have theorized that limiting the use of HA may reduce the costs of OA treatment, HA only comprised a small fraction (3%) of the overall costs. Among patients who underwent knee arthroplasty, those treated with HA experienced elevated costs from the surgery later than those without HA, which reflects their longer time to undergoing knee arthroplasty. The ability to delay or avoid knee arthroplasty altogether can have a substantial impact on the cost to the healthcare system.

Hyaluronic Acid Injections for Knee Osteoarthritis

“…Additionally, despite mixed evidence regarding its efficacy, HA continues to serve as an alternative treatment modality for patients who are not mentally prepared for TKA or who are not indicated for surgical management 29,30 . Furthermore, the ability to delay or avoid TKA in younger patients may help mitigate the substantial economic burden demonstrated in our analysis 31 and, subsequently, has resulted in various professional societies recommending that HA be used judiciously among certain patients 12,32-35 . However, the conflicting viewpoints among governing bodies and orthopaedic surgeons 14 continue to limit a consensus stance on the use of HA, and thus may have contributed to the nonsignificant change in utilization rates that were seen in our analysis.…”

Time to Total Knee Arthroplasty after Intra-Articular Hyaluronic Acid or Platelet-Rich Plasma Injections: A Systematic Literature Review and Meta-Analysis

“…The total savings for patients who received IA HA injections and did not undergo TKA would have been up to US 1.84 billion dollars [ 41 ]. In another study, HA injections represented only a small fraction (3%) of the overall costs [ 65 ].…”

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

“…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.…”