Miller Larry E, Sloniewsky Michael J, Gibbons Thomas E, Johnston Janice G, Vosler Kent D, Nasir Saad
Miller Scientific Consulting, Inc., Asheville, NC.
RMG Holding, Inc., Florence.
J Pain Res. 2017 May 5;10:1045-1054. doi: 10.2147/JPR.S132497. eCollection 2017.
Given the poor long-term effectiveness of focused nonsurgical knee osteoarthritis (OA) treatments, alternative therapies are needed for patients who have unsuccessfully exhausted nonsurgical options.
A telephone interview was conducted in patients who participated in a single 8-week multimodal knee OA treatment program (mean follow-up: 3.7 years, range: 2.7-4.9 years). The program consisted of five intra-articular knee injections of sodium hyaluronate (Hyalgan), with each injection given 1 week apart, structured physical therapy, knee bracing, and patient education. Clinical outcomes included knee pain severity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscores, current medication use, and history of total knee arthroplasty. Base-case, subgroup, and sensitivity analyses were conducted to determine the incremental cost-effectiveness ratio (ICER) of the treatment program with comparisons made to historical literature controls undergoing usual care.
A total of 218 patients (54%) provided long-term follow-up data. Knee pain severity decreased 60% and WOMAC subscores decreased 33%-42% compared to baseline (all <0.001). Total knee arthroplasty was performed in 22.8% (81/356) of knees during followup. The treatment program was highly cost-effective compared to usual care with a base-case ICER of $6,000 per quality-adjusted life year (QALY). Results of subgroup analyses, one-way deterministic sensitivity analyses, and second-order probabilistic sensitivity analyses resulted in ICERs ranging from $3,996 to $10,493 per QALY. The percentage of simulations with an ICER below willingness-to-pay limits was 97.2%, 98.9%, and 99.4% for the $50,000, $100,000, and $150,000 per QALY thresholds, respectively.
Participation in a single 8-week knee OA treatment program, which included one cycle of five intra-articular knee injections of sodium hyaluronate given at weekly intervals, is highly cost-effective and provides clinically meaningful reductions in patient symptoms that are maintained over 3.7 years mean follow-up.
鉴于针对膝关节骨关节炎（OA）的非手术聚焦治疗的长期效果不佳，对于那些已用尽非手术治疗方案但未成功的患者，需要替代疗法。
对参加单一8周多模式膝关节OA治疗项目的患者进行电话访谈（平均随访：3.7年，范围：2.7 - 4.9年）。该项目包括五次膝关节腔内注射透明质酸钠（海乐妙），每次注射间隔1周，有结构化的物理治疗、膝关节支具和患者教育。临床结果包括膝关节疼痛严重程度、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）子评分、当前用药情况以及全膝关节置换术史。进行了基础病例、亚组和敏感性分析，以确定该治疗项目的增量成本效益比（ICER），并与接受常规治疗的历史文献对照进行比较。
共有218名患者（54%）提供了长期随访数据。与基线相比，膝关节疼痛严重程度降低了60%，WOMAC子评分降低了33% - 42%（均P<0.001）。随访期间，22.8%（81/356）的膝关节进行了全膝关节置换术。与常规治疗相比，该治疗项目具有很高的成本效益，基础病例ICER为每质量调整生命年（QALY）6000美元。亚组分析、单向确定性敏感性分析和二阶概率敏感性分析的结果显示，ICER为每QALY 3996美元至10493美元。对于每QALY阈值为50000美元、100000美元和150000美元的情况，ICER低于支付意愿限值的模拟百分比分别为97.2%、98.9%和99.4%。
参加单一8周的膝关节OA治疗项目，其中包括一个周期的每周一次共五次膝关节腔内注射透明质酸钠，具有很高的成本效益，并能在平均3.7年的随访中使患者症状得到临床意义上的减轻。
