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

Alberto Migliore; Davide Integlia; Giuseppe Pompilio; Francesca Di Giuseppe; Cinzia Aru; Tray Brown

doi:10.2147/CEOR.S194669

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

Clinicoecon Outcomes Res. 2019 Jul 22:11:453-464. doi: 10.2147/CEOR.S194669. eCollection 2019.

Authors

Alberto Migliore¹, Davide Integlia², Giuseppe Pompilio², Francesca Di Giuseppe², Cinzia Aru², Tray Brown³

Affiliations

¹ Unit of Rheumatology, San Pietro Fatebenefratelli Hospital, Rome, Italy.
² ISHEO Srl, Rome, Italy.
³ Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: budget impact; cost-effectiveness; hylan G-F 20; osteoarthritis; total knee or hip replacement; viscosupplementation.