Center for Outcomes Research, 186 Bluff Road, Cedar Point, NC 28584, United States.
Bioventus LLC, 4721 Emperor Blvd, #100, Durham, NC 27703, United States.
Semin Arthritis Rheum. 2020 Dec;50(6):1525-1534. doi: 10.1016/j.semarthrit.2020.01.003. Epub 2020 Jan 17.
To compare the medical costs associated with treatments for knee osteoarthritis (OA): intra-articular corticosteroids (ICS) and intra-articular hyaluronic acid (IHA) primarily, and ICS/IHA vs knee arthroplasty (TKA) secondarily.
This was a retrospective analysis of an insurance claims database. Eligible members had diagnosed OA and no claims for ICS, IHA, or TKA during the 6-18-month look-back period. Cohorts of interest over the 4-year observation period were: patients who received ICS only, those who received IHA only, and those who received TKA only. Outcomes assessed included: (1) total allowed medical costs, (2) claims for pre-specified, treatment-related adverse outcomes and costs, and (3) opioid and/or prescription analgesic use and costs. Data extraction began on the date of the first ICS, IHA, or TKA in 2013 until December 31, 2017.
Of the 260,828 patients who qualified, 126,831 were taking monotherapy (IHA=3703, ICS=117,588, TKA = 5540). Adjusted 4-year per patient per month (PPPM) costs were lowest in the IHA cohort ($733); PPPM costs were $1230 in the ICS cohort and $1548 in the TKA cohort. A smaller percentage of patients in the IHA (7.1%) vs ICS (8.4%) or TKA cohort (11.8%) experienced any of the pre-specified adverse outcomes. Adverse outcome-related costs in the IHA cohort were lower ($19.91) than costs in the ICS ($32.18) and TKA cohorts ($31.12). Per-patient opioid and analgesic prescriptions were consistently and significantly lower in the IHA (range, 0.70-0.96) vs ICS cohort (range, 2.0-2.26) for Years 1 through 4. Usage rates were significantly lower in the IHA cohort vs TKA cohort in Year 1 (0.96 vs 4.77) and not different in Years 2 through 4 (TKA range, 0.76-1.08). In Year 1, opioid and prescription analgesic costs were significantly lower in the IHA vs ICS and TKA cohorts ($3.45 vs $11.14 and $12.82). After Year 1, opioid and prescription analgesic costs were significantly higher in the ICS (range, $13.83-15.96) vs IHA (range, $3.02-3.87) and TKA cohorts (range, $3.43-4.97).
Patients in the IHA cohort had lower total medical care costs, fewer adverse outcomes, and lower use/costs of opioids and prescription analgesics vs patients in the ICS and TKA cohorts. Reducing total medical care costs and minimizing opioid/analgesic use should be a treatment goal when selecting therapies for patients with knee OA.
比较膝关节骨关节炎（OA）治疗相关的医疗费用：主要为关节内皮质类固醇（ICS）和关节内透明质酸（IHA），其次为 ICS/IHA 与膝关节置换术（TKA）。
这是一项保险索赔数据库的回顾性分析。合格的患者在 6-18 个月的回顾期内诊断为 OA，且没有 ICS、IHA 或 TKA 的索赔。在 4 年的观察期内，有兴趣的队列包括：仅接受 ICS 的患者、仅接受 IHA 的患者和仅接受 TKA 的患者。评估的结果包括：（1）总允许医疗费用，（2）预定治疗相关不良后果和费用的索赔，（3）阿片类药物和/或处方镇痛药的使用和费用。数据提取始于 2013 年首次接受 ICS、IHA 或 TKA 的日期，直到 2017 年 12 月 31 日。
在符合条件的 260828 名患者中，有 126831 名患者接受单药治疗（IHA=3703，ICS=117588，TKA=5540）。调整后的 4 年每个患者每月（PPPM）费用最低的是 IHA 队列（$733）；ICS 队列的 PPPM 费用为$1230，TKA 队列为$1548。IHA 队列（7.1%）比 ICS（8.4%）或 TKA 队列（11.8%）经历任何预定不良后果的患者比例更小。IHA 队列的不良后果相关费用较低（$19.91），而 ICS（$32.18）和 TKA 队列（$31.12）的费用较高。在第 1 年至第 4 年，IHA 队列（范围，0.70-0.96）的阿片类药物和镇痛药处方明显低于 ICS 队列（范围，2.0-2.26）。在第 1 年，IHA 队列（0.96 vs 4.77）与 TKA 队列（0.76-1.08）相比，使用率明显较低，而在第 2 年至第 4 年，IHA 队列与 TKA 队列的使用率无差异。在第 1 年，IHA 队列（$3.45 vs 11.14 和$12.82）的阿片类药物和处方镇痛药费用明显低于 ICS 和 TKA 队列。第 1 年后，ICS 队列（范围，$13.83-15.96）的阿片类药物和处方镇痛药费用明显高于 IHA 队列（范围，$3.02-3.87）和 TKA 队列（范围，$3.43-4.97）。
与 ICS 和 TKA 队列相比，IHA 队列的患者总医疗费用较低、不良后果较少，且阿片类药物和处方镇痛药的使用/费用较低。在为膝关节 OA 患者选择治疗方法时，降低总医疗费用和尽量减少阿片类药物/镇痛药的使用应作为治疗目标。
