Changes in prescription pain medication and intra-articular corticosteroid utilization after intra-articular bio-fermentation derived hyaluronic acid use in patients undergoing multimodal pain management

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© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

Table 1. Study cohort patient characteristics.

Patient characteristics	n (%)
Gender
Male	5,075 (36.3)
Female	8,924 (63.7)
Age (years)
18–44	1,104 (7.9)
45–49	1,253 (9.0)
50–54	2,205 (15.8)
55–59	2,897 (20.7)
60–64	2,901 (20.7)
65–69	1,188 (8.5)
70–74	966 (6.9)
75–79	660 (4.7)
80–84	480 (3.4)
85+	345 (2.5)
Charlson comorbidity score
0	9,088 (64.9)
1–2	3,322 (23.7)
3–4	834 (6.0)
5+	755 (5.4)
Census region
Northeast	2,806 (20.0)
Midwest	3,741 (26.7)
South	5,799 (41.4)
West	1,542 (11.0)
Unknown	111 (0.8)
Physical therapy use*
No	12,671 (90.5)
Yes	1,328 (9.5)
Knee arthroscopy use*
No	12,369 (88.4)
Yes	1,630 (11.6)
Knee brace use*
No	12,652 (90.4)
Yes	1,347 (9.6)
Concurrent multimodal therapy+
Opioids only	1,274 (9.1)
CS injection only	3,174 (22.7)
Non-opioids only	3,636 (26.0)
Opioids and CS injection	778 (5.6)
Opioids and non-opioids	1,562 (11.2)
CS injection and non-opioids	2,332 (16.7)
Opioids, non-opioids, and CS injection	1,243 (8.9)

*Within 6 months prior to initiation of Bio-HA treatment.

+During the 4-month period centered around the first of the index Bio-HA injections.

Abbreviation: CS, corticosteroid.

Figure 1. Opioid utilization during the multimodal period and after Bio-HA use (top left: mean opioid use per month; top right: opioid days supplied per month; bottom: percent with opioid use).

Table 2. Changes in utilization during the multimodal period and after Bio-HA use.

Utilization	During multimodal period	After Bio-HA use	Comparison
Opioids
Total number of filled prescriptions, overall	11,652 (over 4 months)	28,615 (over 10 months)
Monthly number of filled prescriptions, overall	2,913.0	2,861.5
Mean number of filled prescriptions per user	2.4 ± 2.1 (over 4 months)	4.3 ± 4.9 (over 10 months)
Mean number of filled prescriptions per user per month	0.60 ± 1.05	0.43 ± 1.55	p < 0.001
Total number of opioid days supplied, overall	195,657 (over 4 months)	397,302 (over 10 months)
Monthly number of opioid days supplied, overall	48,914	39,730
Mean number of opioid days supplied per user	40.3 ± 56.6 (over 4 months)	59.7 ± 85.9 (over 10 months)
Mean number of opioid days supplied per user per month	10.1 ± 28.3	6.0 ± 27.2	p < 0.001
Percent of patients with filled prescriptions	34.7% (over 4 months)	47.5% (over 10 months)	p < 0.001
Normalized monthly rate of percent of patients with filled prescriptions	8.7%	4.8%
Corticosteroid (CS) injections
Percent of patients with CS injections	53.8%	29.6%	p < 0.001
Total number of CS injections, overall	9,167 (over 4 months)	6,628 (over 10 months)
Monthly number of CS injections, overall	2,292	663

Figure 2. CS injection utilization during the multimodal period and after Bio-HA use (left: percent with CS injection use; right: total CS injections per month).