Cost Effectiveness of Intra-Articular Hyaluronic Acid and Disease-Modifying Drugs in Knee Osteoarthritis
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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.
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.
- 3.Horizon 2020—European Commission. Horiz. 2020. http://ec.europa.eu/programmes/horizon2020/. Accessed 13 Apr 2015.
- 7.Jordan JM, Helmick CG, Renner JB, Luta G, Dragomir AD, Woodard J, et al. Prevalence of hip symptoms and radiographic and symptomatic hip osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project. J Rheumatol. 2009;36:809–15.CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Principaux tableaux—Eurostat. http://ec.europa.eu/eurostat/web/population-demography-migration-projections/population-data/main-tables. Accessed 24 Jul 2015.
- 14.Bruyère O, Cooper C, Pelletier J-P, Maheu E, Rannou F, Branco J, et al. A consensus statement on the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) algorithm for the management of knee osteoarthritis-From evidence-based medicine to the real-life setting. Semin Arthritis Rheum. 2016;45:S3–11.CrossRefGoogle Scholar
- 15.PICO ontology| Cochrane Linked Data (beta). http://linkeddata.cochrane.org/pico-ontology. Accessed 3 Sep 2015.
- 16.Cochrane handbook for systematic reviews of interventions. http://handbook-5-1.cochrane.org/. Accessed 7 May 2018.
- 17.Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–40.PubMedPubMedCentralGoogle Scholar
- 18.Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol. 1998;51:1171–8.CrossRefPubMedGoogle Scholar
- 22.Consumer Prices (MEI). http://stats.oecd.org/Index.aspx?DatasetCode=MEI_PRICES. Accessed 13 Apr 2015.
- 27.Torrance GW, Raynauld JP, Walker V, Goldsmith CH, Bellamy N, Band PA, et al. A prospective, randomized, pragmatic, health outcomes trial evaluating the incorporation of hylan G-F 20 into the treatment paradigm for patients with knee osteoarthritis (Part 2 of 2): economic results. Osteoarthr Cartil. 2002;10:518–27.CrossRefPubMedGoogle Scholar
- 33.Hermans J, Reijman M, Goossens LMA, Verburg H, Bierma-Zeinstra SMA, Koopmanschap MA. Cost-utility analysis of high molecular weight hyaluronic acid for knee osteoarthritis in everyday clinical care in patients at a working age: an economic evaluation of a randomized clinical trial. Arthritis Care Res. 2018;70:89–97.CrossRefGoogle Scholar
- 36.Miller LE, Block JE. An 8-week knee osteoarthritis treatment program of hyaluronic acid injection, deliberate physical rehabilitation, and patient education is cost effective at 2 years follow-up: the OsteoArthritis Centers of AmericaSM experience. Clin Med Insights Arthritis Musculoskelet Disord. 2014;7:49–55.CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29:1039–49.CrossRefPubMedGoogle Scholar
- 42.Hiligsmann M, Cooper C, Guillemin F, Hochberg MC, Tugwell P, Arden N, et al. A reference case for economic evaluations in osteoarthritis: an expert consensus article from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum. 2014;44:271–82.CrossRefPubMedGoogle Scholar
- 44.Polimeni JM, Vichansavakul K, Iorgulescu RI, Chandrasekara R. Why perspective matters In health outcomes research analyses. Int Bus Econ Res J. 2013;12(11):1503–12.Google Scholar
- 45.Massetti M, Aballéa S, Videau Y, Rémuzat C, Roïz J, Toumi M. A comparison of HAS & NICE guidelines for the economic evaluation of health technologies in the context of their respective national health care systems and cultural environments. J Mark Access Health Policy. 2015;3:24966.CrossRefGoogle Scholar
- 48.Black C, Clar C, Henderson R, MacEachern C, McNamee P, Quayyum Z, et al. The clinical effectiveness of glucosamine and chondroitin supplements in slowing or arresting progression of osteoarthritis of the knee: a systematic review and economic evaluation. Health Technol Assess. 2009;13:1–148.CrossRefPubMedGoogle Scholar
- 50.Dagenais S. Intra-articular hyaluronic acid (viscosupplementation) for knee osteoarthritis. Issues Emerg Health Technol. 2006;94:1–4.Google Scholar
- 57.Hiligsmann M, Cooper C, Arden N, Boers M, Branco JC, Luisa Brandi M, et al. Health economics in the field of osteoarthritis: an expert’s consensus paper from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum. 2013;43:303–13.CrossRefPubMedGoogle Scholar
- 58.National Institute for Health and Care Excellence. Guide to the methods of technology appraisal 2013. London: National Institute for Health and Care Excellence (NICE); 2013. http://www.ncbi.nlm.nih.gov/books/NBK395867/. Accessed 8 Feb 2018.
- 61.Gafni A, Birch S. Incremental cost-effectiveness ratios (ICERs): the silence of the lambda. Soc Sci Med. 1982;2006(62):2091–100.Google Scholar