Cost-effectiveness analysis of knee osteoarthritis treatment with sodium hyaluronate 25mg/2,5mL in the Brazilian public healthcare system

Abstract

OBJECTIVE: To develop a cost-effectiveness and budget impact analysis of intra-articular sodium hyaluronate 25 mg/2.5 ml (SH) versus total knee arthroplasty (TKA) in the treatment of knee osteoarthritis (KOA) grades II and III of Kellgren-Lawrence classification, in patients who failed conservative treatment, under the Brazilian public healthcare system (BPHS) perspective. METHODS: A Markov model was developed to project costs and outcomes associated with KOA progression in three years. All patients were eligible to surgery and could either receive SH or undergo TKA immediately. The outcome was expressed as the number of avoided TKAs. A budget impact analysis was developed considering the year of 2009. RESULTS: In a three year time horizon, total costs per patient were R$4,823.11 (USD 3,653.87 PPP 2007) for the SH group and R$6,133.20 (USD 4,646.36) for the TKA group. The reduction in the absolute number of surgeries was 72.8% in the SH group, compared with TKA. Likewise, there was a cost reduction of R$1,310.09 (USD 992.49), in favor of SH. Conside[1]ring 3,991 eligible patients in the public system, the total annual costs for SH and TKA groups were R$7,190,728.00 (USD 5,447,521.21) and R$24,477,604.86 (USD 18,543,640.05), respectively. As a result, the budget impact was R$17,286,876.86 (USD 13,096,118.83), in favor of SH. The sensitivity analysis showed a cost-saving result until a four-year time horizon. CONCLUSIONS: The use of SH after failure of conservative treatment in patients with grades II or III KOA showed to be effective, leading to a reduction in costs and number of surgeries in three years.