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

AimsThe study objective was to compare the six-month medical/pharmacy costs and healthcare resource utilization (HCRU) for knee OA patients undergoing intra-articular therapy with different classes of HA (by molecular weight) or corticosteroid (ICS).Materials and MethodsPatients across four therapy groups (HMW HA, medium molecular weight (MMW) HA, LMW HA, or ICS) were matched from a U.S. claims database (Optum's de-identified Clinformatics® Data Mart Database), with a final sample size of 6,234 patients per group. Six-month medical/prescription costs per patient per month (PPPM), along with HCRU rates and costs, were determined, adjusting for various factors. Secondary endpoints included complication rates and adjusted costs, new prescription analgesic use, and adjunctive/supplemental intra-articular treatment.ResultsMean adjusted PPPM medical costs were highest for LMW HA ($527.14), followed by HMW HA ($469.35) and MMW HA ($441.97) (p < 0.001), and lowest for the ICS group ($240.26; p < 0.001). 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.LimitationsClaims data was analyzed, which contain limited clinical data and relied on the accuracy of coding of diagnoses and procedures.ConclusionsAmong 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.