, Volume 36, Issue 11, pp 1321–1331 | Cite as

Cost Effectiveness of Intra-Articular Hyaluronic Acid and Disease-Modifying Drugs in Knee Osteoarthritis

  • Jean-Hugues SalmonEmail author
  • Anne-Christine Rat
  • Isabelle Charlot-Lambrecht
  • Jean-Paul Eschard
  • Damien Jolly
  • Bruno Fautrel
Systematic Review



The place of disease-modifying osteoarthritis drugs (DMOADs) and intra-articular hyaluronic acid (IAHA) in the therapeutic arsenal for knee osteoarthritis (OA) remains uncertain. Indeed, these treatments have demonstrated symptomatic efficacy but no efficacy for disease modification.


This report reviews the cost effectiveness of IAHA and DMOADs used in the treatment of knee OA.


A systematic literature search of the MEDLINE, Scopus, EMBASE and Cochrane databases was performed independently by two rheumatologists who used the same predefined eligibility criteria to identify relevant articles. Papers without abstracts and in languages other than English or French were excluded. Extracted costs were annualised and converted to 2015 euros (€) using the Consumer Price Index of the relevant countries and the 2013 Purchasing Power Parities between these countries and the European Union average.


A total of 95 abstracts were selected, and 13 articles were considered for the review: nine articles on IAHA and four on DMOADs. Only one article directly compared different IAHA compounds. Articles showed substantial heterogeneity in methodological approaches. The incremental cost-effectiveness ratios (ICERs) ranged from €4000 to €57,550 and from €240 to €53,225 per quality-adjusted life-year (QALY) gained for DMOADs and IAHA, respectively.


This review highlights substantial heterogeneity between studies, ranging from a cost saving (or dominating) position to very high ICERs, far above the acceptability threshold of €50,000/QALY. Additional research is needed to determine reliable and robust ICER estimates for knee OA therapies.


Compliance with Ethical Standards

Data Availability Statement

The authors confirm that all relevant data are included in the article and/or its supplementary information files.

Conflict of Interest

Author disclosures of honoraria for advice or public speaking, grants received and/or advisory board participation are as follows: Jean Hugues Salmon has received consultancy fees from Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB. Isabelle Charlot-Lambrecht has received consultancy fees from Amgen and MSD. Jean-Paul Eschard has received consultancy fees from Abbvie, BMS, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, Sanofi and UCB. Bruno Fautrel has received research grants from AbbVie, Lilly, MSD and Pfizer, and consultancy fees from AbbVie, Biogen, BMS, Celgene, Janssen, Lilly, Medac, MSD, NORDIC Pharma, Novartis, Pfizer, Roche, Sanofi-Aventis, SOBI and UCB. Anne-Christine Rat and Damien Jolly declare no conflicts of interest.


No funding was received for this systematic review.

Author Contributions

The design of the study was conceived by JHS, BF and DJ. Data collection, management and analysis were performed by JHS and BF. All authors participated in the interpretation of the results and manuscript writing. All authors have read and approved the final version of the manuscript for publication.

Supplementary material

40273_2018_695_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 16 kb)


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Rheumatology Department, Maison Blanche HospitalReims University HospitalsReimsFrance
  2. 2.Faculty of Medicine, EA 3797University of Reims Champagne-ArdenneReimsFrance
  3. 3.Rheumatology DepartmentCHRU de Nancy, Hôpitaux de BraboisVandoeuvre-lès-NancyFrance
  4. 4.Université de Lorraine, APEMACNancyFrance
  5. 5.INSERM, CIC-EC 1433NancyFrance
  6. 6.Department of Research and Innovation, Robert Debré HospitalReims University HospitalsReimsFrance
  7. 7.Sorbonne Université, Institut Pierre Louis de d’Epidémiologie et Santé Publique, GRC08ParisFrance
  8. 8.Rheumatology DepartmentAP-HP, Pitié-Salpêtrière HospitalParisFrance

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