The potential economic role of regenerative therapy in the treatment of knee osteoarthritis

Background. Osteoarthritis (OA) is a chronic and degenerative pathology that affects joints in particular hands, knees, hip and lower back. The prevalence and incidence is in continuous increase for the advanced ageing of the population and the increasing presence of risk factors such as obesity. OA burden of disease implies high care costs and has an important social impact because it limits people’s every day activities causing pain and mobility reduction. Objectives. The aim of this work is to carry out an economic evaluation of the intra-articular (i.a.) use of the Platelet-Rich Plasma (PRP) therapy in the treatment for knee osteoarthritis. Recently the scientific literature has shown the effectiveness of this treatment. The comparator adopted is the Hyaluronic acid (HA) which represents the standard i.a. therapy. Both therapies can reduce pain, improving patient quality of life, and can help the patient to delay the joint surgery, that represents a high cost for the National Health System. Methods. A cost-effectiveness analysis (CEA) were performed using a decision tree model. The effectiveness outcomes are reported in terms of Quality Adjusted Life Year (QALY). The costs are reported in Euro (€) currency evaluated in 2016. The adopted perspective is the Healthcare System and only direct cost have been included in the analyses. Deterministic and probabilistic sensibility analyses are reported in order to evaluate the robustness of the results and account for the different sources of uncertainty.The analyses have been carried out for three European country: Germany, Italy and France Results. The PRP therapy results more costly but also more effective than HA. Using a Willingness to pay thresholds of € 10,000/QALY, the PRP result the cost-effective therapy with respect to HA, for patient with moderate to severe knee OA.