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膝关节骨关节炎治疗中的关节内注射:成本效益分析

Intra-articular injections for knee osteoarthritis management: Analysis of cost-effectiveness.

作者信息

Mass Hanna, Collins Jamie E, Yang Catherine, Hunter David J, Jones Morgan H, Tsai Love, Messier Stephen P, Neogi Tuhina, Katz Jeffrey N, Losina Elena

机构信息

Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.

Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.

出版信息

Osteoarthr Cartil Open. 2025 Jun 10;7(3):100641. doi: 10.1016/j.ocarto.2025.100641. eCollection 2025 Sep.


DOI:10.1016/j.ocarto.2025.100641
PMID:40703537
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12284352/
Abstract

OBJECTIVE: Intra-articular injections (IAI) are commonly used to treat knee pain in persons with knee osteoarthritis (OA). We sought to determine the value of commonly used IAIs in knee OA management. METHODS: We used the validated Osteoarthritis Policy Model (OAPol) to assess the value of saline, corticosteroid (CS), hyaluronic acid (HA), and platelet-rich plasma (PRP) IAIs in knee OA management. We conducted a meta-analysis of high quality studies to estimate IAI-specific pain reduction. We assumed that repeat CS injections increase the risk of OA progression threefold in the base case. We determined the value of specific IAIs with incremental cost-effectiveness ratios (ICERs). We conducted sensitivity analyses to account for uncertainty in input parameters. RESULTS: In the base case, ICERs were $8300/QALY for saline compared to no injection, $54,500/QALY for HA compared to saline, and $112,100/QALY for PRP compared to HA. CS was dominated (more costly, less effective) by saline. In sensitivity analyses that assumed CS does not increase OA progression, ICERs were $6000/QALY for CS compared to no injection, HA dominated compared to CS. ICER for PRP was estimated at $151,300/QALY. ICERs for PRP were higher than currently accepted willingness to pay thresholds. PRP ICER ranges were most sensitive to discontinuation probability and cost. CONCLUSIONS: CS could offer good value for knee OA management if the impact on OA progression is small. . Better data on the impact of CS on OA progression and pain efficacy related to PRP would offer critical insights for policymakers into the value of specific IAIs in the management of knee OA.

摘要

目的:关节内注射(IAI)常用于治疗膝关节骨关节炎(OA)患者的膝关节疼痛。我们试图确定常用IAI在膝关节OA治疗中的价值。 方法:我们使用经过验证的骨关节炎政策模型(OAPol)来评估生理盐水、皮质类固醇(CS)、透明质酸(HA)和富血小板血浆(PRP)关节内注射在膝关节OA治疗中的价值。我们对高质量研究进行了荟萃分析,以估计IAI特异性疼痛减轻情况。在基础案例中,我们假设重复注射CS会使OA进展风险增加三倍。我们用增量成本效益比(ICER)确定了特定IAI的价值。我们进行了敏感性分析,以考虑输入参数的不确定性。 结果:在基础案例中,与不注射相比,生理盐水的ICER为每质量调整生命年8300美元,与生理盐水相比,HA的ICER为每质量调整生命年54500美元,与HA相比,PRP的ICER为每质量调整生命年112100美元。CS被生理盐水主导(成本更高,效果更差)。在假设CS不会增加OA进展的敏感性分析中,与不注射相比,CS的ICER为每质量调整生命年6000美元,HA比CS更具优势。PRP的ICER估计为每质量调整生命年151300美元。PRP的ICER高于目前公认的支付意愿阈值。PRP的ICER范围对停药概率和成本最为敏感。 结论:如果对OA进展的影响较小,CS可能为膝关节OA治疗提供良好价值。关于CS对OA进展的影响以及与PRP相关的疼痛疗效的更好数据,将为政策制定者提供有关特定IAI在膝关节OA治疗中价值的关键见解。

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本文引用的文献

[1]
The burden of knee osteoarthritis worldwide, regionally, and nationally from 1990 to 2019, along with an analysis of cross-national inequalities.

Arch Orthop Trauma Surg. 2024-6

[2]
Longitudinal MRI-defined Cartilage Loss and Radiographic Joint Space Narrowing Following Intra-Articular Corticosteroid Injection for Knee Osteoarthritis: A Systematic Review and Meta-analysis.

Osteoarthr Imaging. 2023-9

[3]
Current Status and Advancements in Platelet-Rich Plasma Therapy.

Cureus. 2023-10-17

[4]
There Is Wide Variation in Platelet-rich Plasma Injection Pricing: A United States Nationwide Study of Top Orthopaedic Hospitals.

Clin Orthop Relat Res. 2024-4-1

[5]
Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021.

Lancet Rheumatol. 2023-8-21

[6]
Cost-utility analysis and net monetary benefit of Platelet Rich Plasma (PRP), intra-articular injections in compared to Plasma Rich in Growth Factors (PRGF), Hyaluronic Acid (HA) and ozone in knee osteoarthritis in Iran.

BMC Musculoskelet Disord. 2023-1-11

[7]
Does gabapentin provide benefit for patients with knee OA? A benefit-harm and cost-effectiveness analysis.

Osteoarthritis Cartilage. 2023-2

[8]
Role and Effectiveness of Intra-articular Injection of Hyaluronic Acid in the Treatment of Knee Osteoarthritis: A Systematic Review.

Cureus. 2022-4-26

[9]
AAOS Clinical Practice Guideline Summary: Management of Osteoarthritis of the Knee (Nonarthroplasty), Third Edition.

J Am Acad Orthop Surg. 2022-5-1

[10]
Do Glucocorticoid Injections Increase the Risk of Knee Osteoarthritis Progression Over 5 Years?

Arthritis Rheumatol. 2022-8

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