Economic value of intra-articular knee OA therapies: a U.S. perspective.

Abstract

Aims: This study compared the six-month medical/pharmacy costs and healthcare resource utilization (HCRU) for knee OA patients undergoing intra-articular therapy with different classes of hyaluronic acid (HA) (by molecular weight) or corticosteroid (ICS).

Materials and methods: Patients across high molecular weight (HMW) HA, medium molecular weight (MMW) HA, low molecular weight (LMW) HA, and ICS therapy groups were matched from a U.S. claims database (Optum's de-identified Clinformatics Data Mart Database), with a final size of 6,234 patients per group. Adjusted six-month medical/prescription costs per patient per month (PPPM), and HCRU rates and costs, were determined. Secondary endpoints included complication rates and adjusted costs, new prescription analgesic use, and adjunctive/supplemental intra-articular treatment.

Results: Mean adjusted PPPM medical costs were highest for LMW HA ($527.14), followed by HMW HA ($469.35) and MMW HA ($441.97) (p < .001), and lowest for the ICS group ($240.26; p < .001). Office visit, arthrocentesis, and subsequent ICS/arthrocentesis rates and corresponding costs, as well as costs for any complications, decreased from LMW HA to MMW HA to HMW HA. The ICS group had greater arthrocentesis, subsequent ICS/arthrocentesis, and office visit costs versus MMW and HMW HA groups. The ICS group had higher rates of new prescription analgesic use (15.8% versus 11.7%-12.2%) and adjunctive ICS (21.8% vs. 9.4%-11.1%) and HA (14.1% versus 1.6%-5.3%) treatment than the HA groups. HMW HA had the lowest rates of adjunctive non-index HA treatment.

Limitations: Claims data contains limited clinical data and relied on the accuracy of coding of diagnoses and procedures.

Conclusions: Among HA products, HMW HA may provide greater short-term clinical and economic benefits. Additionally, intra-articular HA therapy may provide improved short-term clinical and economic results over ICS, in terms of lower rates of adjunctive intra-articular treatments, HCRU, and new prescription analgesic use. Complication rates were low reflecting the safety profiles of HA and ICS.