Premium
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
Author(s) -
Hermans Job,
Reijman Max,
Goossens Lucas M. A.,
Verburg Hennie,
BiermaZeinstra Sita M. A.,
Koopmanschap Marc A.
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23242
Subject(s) - medicine , confidence interval , physical therapy , cost–utility analysis , randomized controlled trial , quality adjusted life year , osteoarthritis , quality of life (healthcare) , economic evaluation , clinical trial , cost effectiveness , alternative medicine , risk analysis (engineering) , nursing , pathology
Objective Knee osteoarthritis ( OA ) is associated with high medical costs and especially with high productivity costs, in particular in patients in their working years. High molecular weight ( HMW ) hyaluronic acid ( HA ) is an alternative treatment for nonsteroidal antiinflammatory drugs, which are known for their serious side‐effects. The cost‐utility of intraarticular HMW ‐ HA treatment in these patients is unknown, however, and was assessed in this study. Methods Secondary care patients ages 18–65 years with knee OA were randomized to usual care plus HMW ‐ HA (intervention group) or to usual care only (control group). A cost‐utility analysis over 52 weeks from the societal and health care perspective was performed. Uncertainty for costs, effects, and cost‐utility ratio was analyzed by nonparametric bootstrapping. Baseline imbalance adjustment was done by inverse probability of treatment weighting. Results In total, 156 subjects were included (intervention group n = 77, control group n = 79). The total of productivity and medical costs was €475 higher in the intervention group at €7,754 (95% confidence interval [95% CI ] 5,426, 10,436) versus €7,270 (95% CI 5,453, 9,262). The amount of quality‐adjusted life years ( QALY s) gained during followup was also higher in the intervention group (0.779 versus 0.727). This variation resulted in an incremental cost‐effectiveness ratio of €9,100/ QALY from a societal perspective and €8,700/ QALY from a health care perspective. When the maximum willingness to pay for conditions similar to knee OA is considered, the probability on cost‐effectiveness is 64% and 86%, respectively. Conclusion Intraarticular HMW ‐ HA added to usual care for knee OA is probably cost‐effective in the treatment of knee OA .