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Comparative Study
. 2020 Aug 6;15(1):305.
doi: 10.1186/s13018-020-01848-7.

Knee OA cost comparison for hyaluronic acid and knee arthroplasty

Kevin L Ong  1 , Faizan Niazi  2 , Edmund Lau  3 , Michael A Mont  4 , Andrew Concoff  5 , Peter Shaw  2 , Steven M Kurtz  6
Affiliations
Comparative Study

Knee OA cost comparison for hyaluronic acid and knee arthroplasty

Kevin L Ong et al. J Orthop Surg Res. .

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.

Keywords: Direct costs; Economic burden; Hyaluronic acid; Knee arthroplasty.

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Conflict of interest statement

KLO is an employee and shareholder of Exponent, a scientific and engineering consulting firm. Exponent has been paid fees for KLO’s consulting services on behalf of such companies and suppliers (Medtronic, Stryker Orthopaedics, Sanofi, Ferring Pharmaceuticals, Paradigm Spine, Pacira Pharmaceuticals, St. Jude Medical, Relievant Medsystems, Zimmer Biomet, Joerns Healthcare, SpineFrontier, Ethicon, DJO, Ossur, Karl Storz Endoscopy-America).

EL is an employee and shareholder of Exponent, a scientific and engineering consulting firm. Exponent has been paid fees for KLO’s consulting services on behalf of such companies and suppliers (Medtronic, Stryker Orthopaedics, Sanofi, Ferring Pharmaceuticals, Paradigm Spine, Pacira Pharmaceuticals, Relievant Medsystems).

SMK is an employee and shareholder of Exponent, a scientific and engineering consulting firm. Exponent has been paid fees for SMK’s consulting services on behalf of such companies and suppliers (Stryker, Zimmer Biomet, Invibio, Stelkast, Wright Medical Technology, Ceramtec, Celanese, Simplify Medical, Formae, and Ferring Pharmaceuticals).

MAM reports personal fees from CyMedica, personal fees from Flexion Therapeutics, personal fees from DJ Orthopaedics, personal fees from Johnson and Johnson, personal fees from Ongoing Care Solutions, personal fees from Orthosensor, personal fees from Pacira, personal fees from Peerwell, personal fees from Performance Dynamics, personal fees from Pfizer, personal fees from Stryker, personal fees from Skye Biologics, personal fees from TissueGene, and non-financial support from US Medical Innovations, outside the submitted work.

AC reports other from Ferring Pharmaceuticals and other from Flexion Therapeutics, outside the submitted work.

PS (at time of study) and FN: employees of Ferring Pharmaceuticals, Inc.

Figures

Fig. 1
Fig. 1
Contributions of various therapies to the overall cost of treating 1,567,024 knee OA patients. As calculated by the authors, the top five largest contributors to the non-specific “other” category included other/unspecified operations on skin/subcutaneous tissue (US$ 43.8 million), subsequent total hip arthroplasties (US$ 39.6 million), subsequent lumbar spine fusions (US$ 10.5 million), continuous passive motion devices (US$ 9.0 million), and unclassified drugs (US$ 4.7M)
Fig. 2
Fig. 2
Median cost for HA and no-HA patients with and without knee arthroplasty in the months following knee OA diagnosis (with 25th and 75th percentile bands)
See this image and copyright information in PMC

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