Nicholls Mathew, Niazi Faizan, Nelson Winnie W, Lau Edmund, Kurtz Steven M, Ong Kevin L
Virginia Mason Orthopaedics and Sports Medicine, Seattle, WA, USA.
Ferring Pharmaceuticals Inc, Parsippany, NJ, USA.
Clinicoecon Outcomes Res. 2022 Aug 30;14:575-585. doi: 10.2147/CEOR.S347512. eCollection 2022.
Limiting access to intra-articular knee injections, including hyaluronic acid (HA), has been advocated as a cost-containment measure in the treatment of knee osteoarthritis. The association between presurgical injections and post-surgical complications such as early periprosthetic joint infection and revision remained to be investigated. This study evaluated pre- and post-surgical costs and rates of post-surgical complications in knee arthroplasty (KA) patients with or without prior HA use.
Commercial and Medicare Supplemental Claims Data (IBM MarketScan Research Databases) from January 1, 2012 to December 31, 2018 were used to identify unilateral KA patients. Those who completed a course of bio-fermentation derived HA (Bio-HA) as the first-line HA therapy comprised of the test group (n = 4091), while the control group did not use HA prior to KA (n = 118,659). Using multivariable regression with propensity score (PS) weighting, overall healthcare costs, readmission rates, and revision rates were assessed at six months following KA.
Healthcare costs following KA were significantly lower for the Bio-HA group ($10,021 ± $22,796) than No HA group ($12,724 ± $32,966; PS p < 0.001). Bio-HA patients had lower readmission rates (8.9% vs 14.0%; PS p < 0.001) and inpatient costs per readmitted patient ($43,846 ± $50,648 vs $50,533 ± $66,150; PS p = 0.005). There were no differences in revision rate for any reason (Bio-HA: 0.78% vs No HA: 0.67%; PS p = 0.361) and with PJI (Bio-HA: 0.42% vs No HA: 0.33%; PS p = 0.192). Costs in the six months up to and including the KA were similar for both groups (Bio-HA: $49,759 ± $40,363 vs No HA: $50,532 ± $43,183; PS p = 0.293).
Bio-HA use prior to knee arthroplasty did not appear to increase overall healthcare costs in the six months before and after surgery. Allowing access to HA injections provides a non-surgical therapeutic option without increasing cost or risk of post-surgical complications.
限制膝关节腔内注射，包括透明质酸（HA）的使用，已被倡导作为膝关节骨关节炎治疗中的一项成本控制措施。术前注射与术后并发症（如早期假体周围关节感染和翻修）之间的关联仍有待研究。本研究评估了术前和术后使用或未使用HA的膝关节置换术（KA）患者的手术前后成本及术后并发症发生率。
使用2012年1月1日至2018年12月31日的商业和医疗保险补充索赔数据（IBM MarketScan研究数据库）来识别单侧KA患者。那些完成了一个疗程的生物发酵衍生HA（Bio-HA）作为一线HA治疗的患者组成试验组（n = 4091），而对照组在KA术前未使用HA（n = 118,659）。采用倾向评分（PS）加权的多变量回归分析，在KA术后6个月评估总体医疗成本、再入院率和翻修率。
Bio-HA组KA术后的医疗成本（10,021美元±22,796美元）显著低于未使用HA组（12,724美元±32,966美元；PS p < 0.001）。Bio-HA组患者的再入院率较低（8.9%对14.0%；PS p < 0.001），且每位再入院患者的住院成本较低（43,846美元±50,648美元对50,533美元±66,150美元；PS p = 0.005）。因任何原因的翻修率无差异（Bio-HA组：0.78%对未使用HA组：0.67%；PS p = 0.361），假体周围关节感染（PJI）导致的翻修率也无差异（Bio-HA组：0.42%对未使用HA组：0.33%；PS p = 0.192）。两组在KA术前直至包括KA手术在内的6个月内的成本相似（Bio-HA组：49,759美元±40,363美元对未使用HA组：50,532美元±43,183美元；PS p = 0.293）。
膝关节置换术前使用Bio-HA似乎并未增加手术前后6个月内的总体医疗成本。允许进行HA注射提供了一种非手术治疗选择，且不会增加成本或术后并发症风险。
