Thomas Thierry, Amouroux Françoise, Vincent Patrice
Service Rhumatologie, CHU, St Etienne, France.
UFR Sciences Pharmaceutiques, Bordeaux, France.
PLoS One. 2017 Mar 22;12(3):e0173683. doi: 10.1371/journal.pone.0173683. eCollection 2017.
Pharmaco-economic data on the management of knee osteoarthritis (OA) with intra articular hyaluronic acid (IA HA) viscosupplementation is limited. We contrasted IA HA with non-steroidal anti-inflammatory drugs (NSAIDs).
Observational, prospective and multicenter study comparing treatments of knee OA costs and efficacy with either NSAIDs alone, or hyaluronic acid (Arthrum H 2%®), during a 6-month follow-up period. The investigators were pharmacists who recorded data on disease, drug consumption and healthcare circuit. Retrospectively, the 6-month period preceding inclusion was also studied, to ensure the comparability of groups.
199 patients were analyzed in a NSAIDs group and 202 in an IA HA group. Any of the WOMAC sub-scores and the EQ-5D Quality of Life index were significantly improved in the IA HA group (p<0.0001) at 3 and 6 months. Clinical results were therefore in favor of the IA HA group. The total drug expenses per 6-month period were comparable before and after inclusion, €96 and €98 for NSAIDs group vs €94 and €101 for IA HA group, which indicates no evidence of additional cost from IA HA. For the active part of the population, the incidence of sick leave was lower in the IA HA group, indicating a better maintenance of patient activity. The overall expense on 12 months (6 months before and 6 months after inclusion) for the national health insurance system was comparable for NSAIDs and IA HA groups: €528 and €526, respectively. The number of patients taking NSAIDs significantly decreased in IA HA group (from 100% at inclusion to 66% at 1-3 months and 44% at 4-6 months), but remained unchanged (100%) during the follow-up period, in NSAIDs group.
Treatment with IA HA did not generate additional cost for the national health insurance and was associated with a functional improvement of knee osteoarthritis and Quality of Life. The cost-utility analysis was in favor of IA HA, with a gain of QALY equivalent to half a month, after the 6-month follow-up period comparing both treatments. The NSAIDs consumption was decreased in the IA HA group, resulting in an improved estimated benefit/risk ratio.
关于关节内注射透明质酸（IA HA）黏弹性补充疗法治疗膝关节骨关节炎（OA）的药物经济学数据有限。我们将IA HA与非甾体抗炎药（NSAIDs）进行了对比。
一项观察性、前瞻性多中心研究，比较单独使用NSAIDs或透明质酸（Arthrum H 2%®）治疗膝关节OA的成本和疗效，随访期为6个月。研究者为药剂师，他们记录疾病、药物消费和医疗保健流程的数据。回顾性地研究纳入前的6个月期间，以确保各组的可比性。
NSAIDs组分析了199例患者，IA HA组分析了202例患者。在3个月和6个月时，IA HA组的任何WOMAC子评分和EQ-5D生活质量指数均显著改善（p<0.0001）。因此临床结果支持IA HA组。纳入前后每6个月的总药物费用具有可比性，NSAIDs组为96欧元和98欧元，IA HA组为94欧元和101欧元，这表明没有证据表明IA HA会产生额外费用。对于活跃人群，IA HA组的病假发生率较低，表明患者活动能力维持得更好。国家医疗保险系统在12个月（纳入前6个月和纳入后6个月）的总费用，NSAIDs组和IA HA组具有可比性，分别为528欧元和526欧元。IA HA组服用NSAIDs的患者数量显著减少（从纳入时的100%降至1 - 3个月时的66%和4 - 6个月时的44%），但在随访期间NSAIDs组保持不变（100%）。
IA HA治疗未给国家医疗保险带来额外费用，且与膝关节骨关节炎功能改善和生活质量提高相关。在对两种治疗进行6个月随访期比较后，成本效益分析支持IA HA，获得了相当于半个月的质量调整生命年（QALY）收益。IA HA组的NSAIDs消费量减少，导致估计的效益/风险比得到改善。
