Sunday, November 13, 2016

Intraarticular injection of hyaluronic acid (HA) - are we spending our money wisely?

Hyaluronic Acid Injections for Treatment of Advanced Osteoarthritis of the Knee: Utilization and Cost in a National Population Sample.

These authors point out that the efficacy and cost-effectiveness of the use of hyaluronic acid (HA) injections for the treatment of knee osteoarthritis are debated. They assessed the utilization and costs of HA injections in the 12 months preceding total knee arthroplasty (TKA) and evaluated the usage of HA injections in end-stage knee osteoarthritis management in relation to other treatments.

They used the MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases (Truven Health Analytics) to identify patients who underwent TKA from 2005 to 2012 and observed the utilization of patient-specific osteoarthritis-related health care (including medications, corticosteroid injections, HA injections, imaging, and office visits) and payment information for the 12 months preceding TKA.

244,059 patients met the inclusion criteria. Of those, 35,935 (14.7%) had ≥1 HA injection in the 12 months preceding TKA. 
HA injections were responsible for 16.4% of all knee osteoarthritis-related payments, trailing only imaging studies (18.2%)
HA injections accounted for 25.2% of treatment-specific payments, a rate that was higher than that of any other treatment. 
Patients receiving HA injections were significantly more likely to receive additional knee osteoarthritis-related treatments compared with patients who did not receive HA injections.

They concluded that "despite numerous studies questioning the efficacy and cost-effectiveness of HA injections for osteoarthritis of the knee, HA injections are still utilized for a substantial percentage of patients. Given the paucity of data supporting the effectiveness of HA injections and the current cost-conscious health-care climate, decreasing their use among patients with end-stage knee osteoarthritis may represent a substantial cost reduction that likely does not adversely impact the quality of care."

Comment: We recently posted Synvisc - does it benefit patients with arthritis more than a cortisone shot? which emphasizes the points made in this article. Recommended reading.


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