Evidence-based review, not change in usage patterns, should drive Medicare Benefit Schedule (MBS) disinvestment decisions

Mundy criticised the PRP RCTs for not having used nonsteroidal anti-inflammatory drugs (NSAIDs) as a control group, citing NSAIDs as the 'mainstay of treatment' for knee OA.1 The paper argues that RCT comparisons between PRP and hyaluronic acid (HA) gel treatments should be disregarded on...

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Bibliographic Details
Published in:Australian health review 2017-12, Vol.41 (6), p.713-714
Main Authors: Orchard, John W, Orchard, Jessica J, Samra, David J
Format: Article
Language:English
Subjects:
Arthritis
Australia
Decision Making, Organizational
Evidence-Based Practice
Funding
Health administration
Humans
Hyaluronic acid
Insurance Coverage - organization & administration
Knee
Medicare
Meta-analysis
National Health Programs - organization & administration
National Health Programs - statistics & numerical data
Nonsteroidal anti-inflammatory drugs
Osteoarthritis
Pain
Patient Acceptance of Health Care - statistics & numerical data
Systematic review
Citations: Items that this one cites
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Summary:Mundy criticised the PRP RCTs for not having used nonsteroidal anti-inflammatory drugs (NSAIDs) as a control group, citing NSAIDs as the 'mainstay of treatment' for knee OA.1 The paper argues that RCT comparisons between PRP and hyaluronic acid (HA) gel treatments should be disregarded on the basis that HA was previously rejected as a funded treatment in Australia in 2003.1 There are many recent systematic reviews (AMSTAR scores 7/11 or higher)4-8 and a Cochrane review9 that support HA use for knee OA, based on over 50 placebocontrolled RCTs,8 that Mundy failed to cite. HA itself has been compared against NSAIDs in RCTs,8 direct systematic reviews10 and indirect systematic reviews,8,11 and is a more effective pain reliever in knee OA than NSAIDs,8,11 safely relieving pain without the side effects of gastrointestinal ulcers and heart attacks associated with NSAIDs.10 By not having defined a consistent threshold for an effective treatment, Mundy was able to accept NSAIDs as the 'mainstay' knee OA treatment and reject HA when the latter is superior in head-to-head comparisons.10 Mundy made brief reference to knee arthroscopy 'offering no benefit in knee OA'1 (we agree it has been proven ineffective and harmful12), but does not comment about the generous MBS funding of knee arthroscopy in OA. CD005321. 10 Bannuru R, Vaysbrot E, Sullivan M, McAlindon T. Relative efficacy of hyaluronic acid in comparison with NSAIDs for knee osteoarthritis: a systematic review and meta-analysis.
ISSN:0156-5788
1449-8944
DOI:10.1071/AH16198