Cost-effectiveness and budget impact analysis of viscosupplementation with hylan G-F 20 for knee and hip osteoarthritis

• Published in: ClinicoEconomics and outcomes research 2019-07, Vol.11, p.453-464
• Main Authors: Migliore, Alberto, Integlia, Davide, Pompilio, Giuseppe, Di Giuseppe, Francesca, Aru, Cinzia, Brown, Tray
• Format: Article
• Language: English
• Subjects: Acetaminophen; Analgesics; Anti-inflammatory agents; Arthritis; budget impact; Budgets; Comparative analysis; Cost analysis; Cost benefit analysis; Cost control; cost-effectiveness; Economic aspects; FDA approval; Hylan; hylan G-F 20; Knee; Markov processes; Original Research; Osteoarthritis; Pain; Patients; Physical therapy; Prostheses; Prostheses and implants; Rheumatology; Socialized medicine; total knee or hip replacement; viscosupplementation
• ISSN: 1178-6981; 1178-6981
• DOI: 10.2147/CEOR.S194669

To estimate the cost-effectiveness and budget impact of viscosupplementation with one intra-articular (IA) injection of 6 mL hylan G-F 20 (Synvisc-One ) and with three injections of 2 mL hylan G-F 20 (Synvisc 3×2) in knee osteoarthritis (OA) patients compared with conventional support therapy (CST - eg, NSAIDs and acetaminophen) and the cost-effectiveness of one IA injection of 2 mL hylan G-F 20 (Synvisc 1×2) in hip OA patients compared with CST from an Italian Health System perspective. The model used was a Markov model with states for stages II-IV on the Kellgren-Lawrence scale and runs on 6-month cycles over a 5-year time horizon. A 3.5% discount was applied to both costs and utilities. Direct costs were determined from the perspective of the Italian National Health Service. A one-way and probabilistic sensitivity analysis was conducted for both comparisons. Hylan G-F 20 1×6 mL and hylan G-F 20 3×2 mL for knee OA were very likely to be cost-effective when compared to acetaminophen (ICER = €3,160.61 and €3,845.81 per QALY, respectively) and NSAIDs as both ICERs are below €25,000. The hip OA treatment by hylan G-F 20 1×2 mL was dominant compared to NSAIDs and very likely compared to acetaminophen. The results of the cost-effectiveness analysis were confirmed by one-way sensitivity analysis. The budget impact analysis for knee and hip OA showed a small increase in expenditure during 5 years. Hylan G-F 20 1×6 mL/hylan G-F 20 is a cost-effectiveness treatment compared to NSAIDs and acetaminophen in the treatment of knee/hip OA in Italy. The treatment of hip and knee OA resulted in cost-saving with hylan G-F 20 1×2 mL and economically sustainable with hylan G-F 20 1×6 mL. However, Real Word Evidence studies should be conducted in order to estimate costs associated with both prosthetics and to understand the reduction of physiotherapy and medication due to hylan G-F 20.