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

Jean-Hugues Salmon (), Anne-Christine Rat (), Isabelle Charlot-Lambrecht (), Jean-Paul Eschard (), Damien Jolly () and Bruno Fautrel ()
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Jean-Hugues Salmon: Reims University Hospitals
Anne-Christine Rat: CHRU de Nancy, Hôpitaux de Brabois
Isabelle Charlot-Lambrecht: Reims University Hospitals
Jean-Paul Eschard: Reims University Hospitals
Damien Jolly: University of Reims Champagne-Ardenne
Bruno Fautrel: Sorbonne Université, Institut Pierre Louis de d’Epidémiologie et Santé Publique, GRC08

PharmacoEconomics, 2018, vol. 36, issue 11, No 3, 1331 pages

Abstract: Abstract Background 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. Objective This report reviews the cost effectiveness of IAHA and DMOADs used in the treatment of knee OA. Methods 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. Results 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. Conclusions 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.

Date: 2018
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DOI: 10.1007/s40273-018-0695-5

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