Ong Kevin L, Runa Maria, Lau Edmund, Altman Roy D
Biomedical Engineering, Exponent, Inc, Philadelphia, PA, USA,
Health Sciences, Exponent, Inc, Menlo Park, CA, USA.
Clinicoecon Outcomes Res. 2019 Mar 14;11:245-255. doi: 10.2147/CEOR.S170119. eCollection 2019.
Although knee arthroplasty (KA) is the largest source of hospitalization costs for knee osteoarthritis (OA), some studies have suggested reducing the use of "low-value" interventions, such as intra-articular hyaluronic acid (HA), to lower health care costs. However, those studies fail to consider that HA has demonstrated benefits in extending time to more costly KA or avoiding KA altogether. We evaluated 1) the overall knee OA costs (direct) within a 2-year period; 2) the relative contribution of HA and KA costs; 3) the direct cost savings from HA patients not undergoing KA.
Knee OA patients were identified from the Optum Clinformatics data set, which includes physician, facility, and pharmacy claims data from privately insured patients of all ages. Patients were stratified in the no HA, non-hylan G-F 20, and hylan G-F 20 cohorts. The cumulative costs (payer perspective) were evaluated for all knee OA-related claims (adjusted to Consumer Price Index Jan 2017$) for patients who had at least 2 years follow-up. Costs were stratified into various clinical categories.
The study cohort included 2,030,497 knee OA patients, of which 65,144 patients (3.2%) underwent KA. The cost of treating knee OA within the 2-year follow-up period was estimated to be $4.99 billion (B). The majority of the costs (69%) were attributed to KA patients (3.2% of patients). In all, 15.9% of the HA patients underwent KA within 2 years, but HA only contributed 1.7% to the total costs for these patients. The remaining 84.1% of HA patients did not undergo KA, which saved an estimated total of $1.54B (average $20,740 per patient) or 83.9%, after accounting for their non-KA therapies.
Our study estimated substantial cost savings through a large percentage of HA patients not undergoing KA. Although a fraction of patients moved on from their conservative therapy to undergo KA within the 2-year period, HA attributed to <2% of their total treatment costs.
尽管膝关节置换术（KA）是膝关节骨关节炎（OA）住院费用的最大来源，但一些研究建议减少使用“低价值”干预措施，如关节内注射透明质酸（HA），以降低医疗保健成本。然而，这些研究没有考虑到HA已被证明在延长至更昂贵的KA的时间或完全避免KA方面具有益处。我们评估了：1）两年内膝关节OA的总体成本（直接成本）；2）HA和KA成本的相对贡献；3）未接受KA的HA患者的直接成本节省情况。
从Optum临床信息数据集识别膝关节OA患者，该数据集包括来自各年龄段私人保险患者的医生、医疗机构和药房索赔数据。患者被分为未使用HA、非高交联G-F 20和高交联G-F 20队列。对至少有两年随访的患者的所有膝关节OA相关索赔（根据2017年1月消费者价格指数调整为美元）的累积成本（付款人角度）进行评估。成本被分为不同的临床类别。
研究队列包括2,030,497名膝关节OA患者，其中65,144名患者（3.2%）接受了KA。两年随访期内治疗膝关节OA的成本估计为49.9亿美元（B）。大部分成本（69%）归因于KA患者（占患者的3.2%）。总共有15.9%的HA患者在两年内接受了KA，但HA仅占这些患者总成本的1.7%。其余84.1%的HA患者未接受KA，在考虑其非KA治疗后，估计总共节省了15.4亿美元（平均每位患者20,740美元），即83.9%。
我们的研究估计，通过很大一部分HA患者未接受KA可大幅节省成本。尽管有一部分患者在两年内从保守治疗转向接受KA，但HA占其总治疗成本的比例不到2%。
