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

Background: The place of disease modifying osteoarthritis drugs and intra-articular hyaluronic acid in the therapeutic arsenal of knee osteoarthritis remains uncertain. Indeed, these treatments have demonstrated symptomatic efficacy but no efficacy for disease modification. Objective: This report reviews the cost effectiveness of intra-articular hyaluronic acid (IAHA) and disease modifying osteoarthritis drugs (DMOADs) used in the treatment of knee osteoarthritis. Methods: A systematic literature search of MEDLINE, Scopus, EMBASE and Cochrane databases for articles was performed independently by 2 rheumatologists who used the same predefined eligible criteria. Papers without abstracts and in languages other than English or French were excluded. Extracted costs were annualized and converted to 2015 euros (€) by 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 were on IAHA and 4 articles on DMOADs. Only one article directly compared different IAHA compound. Articles showed substantial heterogeneity in methodological approaches. The incremental cost-effectiveness ratios (ICER) ranged from 4,000 to 57,550€ and from 240 to 53,225€ per QALY gained for DMOADs and IAHA respectively. Conclusions: This review highlights substantial heterogeneity between studies, ranging from cost saving (or dominating) position to very high ICERs, far above the acceptability threshold of 50,000 €/QALY. Additional research is needed to display reliable and robust ICER estimates for knee OA therapies.