Cost-effectiveness analysis of intra-articular injections of a high molecular weight bioengineered hyaluronic acid for the treatment of osteoarthritis knee pain

Figures & data

Figure 1. (a) Model 1: Cost-effectiveness model of BioHA vs continuation of baseline treatment. (b) Model 2: Cost-effectiveness model of BioHA vs conventional care, responders and non-responders. BioHA, bioengineered hyaluronic acid; OA, osteoarthritis.

Table 1. Models 1 and 2: Input parameters for the base case and ranges of the parameters for sensitivity analysis.

Parameters	Base case	Plausible range
		Low	High
Two courses of BioHA	$684	$547	$821
Cost of 1 physician visit (HCPCS code, 99201)	$42.55	NA	NA
Cost of 1 knee injection (HCPCS code, 20610)	$69.78	NA	NA
Model 1
Annual healthcare costs for conventional treatment of OA with NSAIDs and analgesics	$4562	$3650	$5474
QALYs gained per year
BioHA	0.163	−0.162	0.488
Model 2
Annual healthcare costs for conventional treatment of OA with NSAIDs and analgesics	$516	$413	$619
Response rate of BioHA	56%	45%	67%
Response rate of appropriate care	40%	32%	48%
QALYs gained per year
Responder	0.23	0.184	0.276
Non-responder	0.08	0.064	0.096

BioHA, bioengineered hyaluronic acid; HCPCS, Health Care Financing Administrators Common Procedure Coding System; NSAIDs, non-steroidal anti-inflammatory drugs; OA, osteoarthritis; QALYs, quality-adjusted life years.

Table 2. FLEXX Trial baseline demographics16.

	IA-SA (n = 295)	IA-BioHA (n = 291)
Men, n (%)	109 (37)	107 (37)
Women, n (%)	186 (63)	184 (63)
Age, years, mean (SD)	60.8 (10.0)	62.5 (11.0)
BMI, kg/m^2 (mean)	33.0 (7.0)	32.4 (7.0)
Kellgren-Lawrence grade, n (%)
2	115 (39)	119 (41)
3	180 (61)	172 (59)
Prior year target knee treatment, n (%)	203 (69)	199 (68)
Physical therapy	23 (8)	16 (6)
Arthrocentesis	8 (3)	16 (6)
Steroid injection	52 (18)	55 (19)
Other injection	8 (3)	10 (3)
NSAID	176 (60)	172 (59)
Mean baseline pain (100 mm VAS 50 foot walk), mean (SD)	54.7 (22.0)	55.6 (22.0)

Reprinted with permission from Altman et al.16.

IA-SA, intra-articular buffered saline; IA-BioHA, intra-articular 1% sodium hyaluronate; SD, standard deviation; BMI, body mass index; NSAID, non-steroidal anti-inflammatory drug; VAS, visual analog scale.

Figure 2. HUI-3 scores for all patients, responders, and non-responders with BioHA treatment. HUI-3, Health Utilities Index Mark 3.

Table 3. Model 1: Cost effectiveness of intra-articular BioHA vs conventional care.

Strategy	Cost	Incremental cost	Effectiveness	Incremental effectiveness	Cost- effectiveness	Incremental cost- effectiveness
Conventional care	$4562.00		0.000 QALY			Dominated
BioHA	$3468.78	−$1093.22	0.163 QALY	0.163 QALY	$21,281/QALY

BioHA, bioengineered hyaluronic acid; QALY, quality-adjusted life year.

Table 4. Model 1: Results of one-way sensitivity analysis.

Parameters	Strategy	Cost	Incremental cost	Effectiveness	Incremental effectiveness	Cost effectiveness	ICER
Costs of BioHA
Low	Conventional care	$4562.00		0.0000 QALY			Dominated
	BioHA	$3331.78	−$1230.22	0.1630 QALY	0.1630 QALY	$20,440/QALY
High	Conventional care	$4562.00		0.0000 QALY			Dominated
	BioHA	$3605.78	−$956.22	0.1630 QALY	0.1630 QALY	$22,121/QALY
Costs of conventional treatment
Low	Conventional care	$3,012.78		0.0000 QALY			Dominated
	BioHA	$3,650.00	−$637.22	0.1630 QALY	0.1630 QALY	$18,483/QALY
High	Conventional care	$5474.00		0.0000 QALY			Dominated
	BioHA	$3924.78	−$1549.22	0.1630 QALY	0.1630 QALY	$24,078/QALY
QALYs gained per year in BioHA
Low	Conventional care	$4562.00		0.0000 QALY		NA	$6748/QALY
	BioHA	$3468.78	$1093.22	−0.1620 QALY	0.1620 QALY	NA
High	Conventional care	$4562.00		0.0000 QALY		NA	Dominated
	BioHA	$3468.78	−$1093.22	0.4880 QALY	0.4880 QALY	$7108/QALY

BioHA, bioengineered hyaluronic acid (via intra-articular administration); ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year.

Table 5. Model 2: Base case scenario results.

Strategy	Cost	Incremental cost	Effectiveness (QALY)	Incremental effectiveness (QALY)	Average cost effectiveness	ICER
Conventional treatment	$516.00		0.1400		$3686/QALY
Intra-articular BioHA	$1445.80	$929.80	0.1640	0.0240	$8816/QALY	$38,741/QALY

BioHA, bioengineered hyaluronic acid; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life year.

Figure 3. Model 2: Results of one-way sensitivity analysis. BioHA, bioengineered hyaluronic acid; QALY, quality-adjusted life year.

Figure 4. Model 2: Cost-effectiveness plane of joint distribution of incremental cost and effectiveness for BioHA. The diagonal line represents a willingness-to-pay threshold of $50,000/QALYs. BioHA, bioengineered hyaluronic acid; QALYs, quality-adjusted life years.

Figure 5. Model 2: Cost-effectiveness acceptability curve for BioHA vs conventional care under various willingness-to-pay thresholds. BioHA, bioengineered hyaluronic acid; QALY, quality-adjusted life year.

Altman RD, Rosen JE, Bloch DA, et al. A double-blind, randomized, saline-controlled study of the efficacy and safety of EUFLEXXA for treatment of painful osteoarthritis of the knee, with an open-label safety extension (the FLEXX trial). Semin Arthritis Rheum 2009;39:1-9

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