Intra-articular injections for knee osteoarthritis management: Analysis of cost-effectiveness
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, c...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-09-01
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| Series: | Osteoarthritis and Cartilage Open |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2665913125000779 |
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| author | Hanna Mass Jamie E. Collins Catherine Yang David J. Hunter Morgan H. Jones Love Tsai Stephen P. Messier Tuhina Neogi Jeffrey N. Katz Elena Losina |
| author_facet | Hanna Mass Jamie E. Collins Catherine Yang David J. Hunter Morgan H. Jones Love Tsai Stephen P. Messier Tuhina Neogi Jeffrey N. Katz Elena Losina |
| author_sort | Hanna Mass |
| collection | DOAJ |
| description | 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. If saline was not included, ICER for HA was reduced to $22,400/QALY. 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. Value of PRP depends greatly on its price, with current prices leading to value exceeding well-accepted cost-effectiveness thresholds. 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. |
| format | Article |
| id | doaj-art-3e98c8fa33ab49b6a4426cf26b39fd32 |
| institution | Kabale University |
| issn | 2665-9131 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Osteoarthritis and Cartilage Open |
| spelling | doaj-art-3e98c8fa33ab49b6a4426cf26b39fd322025-08-20T03:51:13ZengElsevierOsteoarthritis and Cartilage Open2665-91312025-09-017310064110.1016/j.ocarto.2025.100641Intra-articular injections for knee osteoarthritis management: Analysis of cost-effectivenessHanna Mass0Jamie E. Collins1Catherine Yang2David J. Hunter3Morgan H. Jones4Love Tsai5Stephen P. Messier6Tuhina Neogi7Jeffrey N. Katz8Elena Losina9Orthopedic 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, USAOrthopedic 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; Harvard Medical School, Boston, MA, USAOrthopedic 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, USARheumatology Department, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, New South Wales, AustraliaOrthopedic 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; Harvard Medical School, Boston, MA, USAOrthopedic 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, USAJ.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USASection of Rheumatology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USAOrthopedic 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; Harvard Medical School, Boston, MA, USAOrthopedic 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; Harvard Medical School, Boston, MA, USA; Corresponding author. Orthopaedic and Arthritis Center for Outcomes Research, Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis St, BTM Suite 5016, Boston, MA 02115, USA. Fax: (617) 525-7900.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. If saline was not included, ICER for HA was reduced to $22,400/QALY. 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. Value of PRP depends greatly on its price, with current prices leading to value exceeding well-accepted cost-effectiveness thresholds. 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.http://www.sciencedirect.com/science/article/pii/S2665913125000779 |
| spellingShingle | Hanna Mass Jamie E. Collins Catherine Yang David J. Hunter Morgan H. Jones Love Tsai Stephen P. Messier Tuhina Neogi Jeffrey N. Katz Elena Losina Intra-articular injections for knee osteoarthritis management: Analysis of cost-effectiveness Osteoarthritis and Cartilage Open |
| title | Intra-articular injections for knee osteoarthritis management: Analysis of cost-effectiveness |
| title_full | Intra-articular injections for knee osteoarthritis management: Analysis of cost-effectiveness |
| title_fullStr | Intra-articular injections for knee osteoarthritis management: Analysis of cost-effectiveness |
| title_full_unstemmed | Intra-articular injections for knee osteoarthritis management: Analysis of cost-effectiveness |
| title_short | Intra-articular injections for knee osteoarthritis management: Analysis of cost-effectiveness |
| title_sort | intra articular injections for knee osteoarthritis management analysis of cost effectiveness |
| url | http://www.sciencedirect.com/science/article/pii/S2665913125000779 |
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