Management of knee osteoarthritis in Italy. A cost-utility analysis of Platelet-Rich-Plasma dedicated kit versus Hyaluronic acid for the intra-articular treatment of knee OA

Background. Osteoarthritis (OA) is a chronic and degenerative pathology that affects joints in particular hands, knees, hip and lower back. It is one of the main causes of disability in most of advanced economy countries. Its prevalence and incidence are increasing for the ageing of population and the presence of risk factors. OA burden of disease implies high costs of care and it has an important social impact. Although more high-quality evidence is needed, recent studies indicate that intra-articular Platelet-Rich Plasma (i.a. PRP) injections can relieve pain, improving knee function and quality of life, especially in younger patients and mild OA cases. Objectives. The aim of this work is to develop a preliminary economic evaluation of i.a. PRP therapy in the treatment of knee OA. The comparator adopted is the Hyaluronic acid (HA) which represents the standard therapy. Both therapies can reduce pain and can help the patient to delay the total knee replacement (TKR) surgical intervention. Methods. A Cost-Utility Analysis (CUA) was performed using a decision tree model. Outcomes are reported in terms of Quality Adjusted Life Year (QALY), while costs are reported in Euro (Û) currency. The adopted perspective is the National Healthcare System. Deterministic and probabilistic sensibility analyses are reported to evaluate the robustness of results under uncertainty. Results. The i.a. PRP-based therapy is cost-effective with respect to HA. Future clinical studies should provide more evidence on the major effectiveness and considering a longer patient follow-up there could be the delay of TKR, reducing consequently the eventual prosthesis revision and reducing costs of knee OA for National Healthcare System.