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A prospective, randomized, pragmatic, health outcomes trial evaluating the incorporation of hylan G-F 20 into the treatment paradigm for patients with knee osteoarthritis (Part 2 of 2): economic results

https://doi.org/10.1053/joca.2001.0513Get rights and content
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Abstract

Objective Viscosupplementation with hylan G-F 20 has recently become registered for treatment of patients with osteoarthritis (OA) of the knee in most parts of the world. The cost effectiveness and cost utility of this new therapeutic modality were determined as part of a Canadian prospective, randomized, 1-year, open-label, multicentered trial.

Design A total of 255 patients were randomized to ‘Appropriate care with hylan G-F 20’ (AC+H) or ‘Appropriate care without hylan G-F 20’ (AC). Costs (1999 Canadian dollars) were collected from the societal viewpoint and included all costs related to OA of the knee and OA in all joints. Patients completed a number of outcomes questionnaires including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Health Utilities Index Mark 3 (HUI3). Data were collected at clinic visits (baseline, 12 months) and by telephone (1, 2, 4, 6, 8, 10, and 12 months).

Results The AC+H group over the year had higher costs ($2125–$1415=$710, P< 0.05), more patients improved (69%–40%=29%,P =0.0001), greater increases in HUI3 (0.13–0.03=0.10, P< 0.0001) and increased quality-adjusted life years (QALYs) (0.071, P< 0.05). The incremental cost-effectiveness ratio was $2505/patient improved. The incremental cost–utility ratio was $10 000/QALY gained. Sensitivity analyses and a second cost perspective gave similar results.

Conclusion The cost–utility ratio is below the suggested Canadian adoption threshold. The results provide strong evidence for adoption of treatment with hylan G-F 20 in the patients and settings studied in the trial. Copyright 2002 OsteoArthritis Research Society International. Published by Elsevier Science Ltd. All rights reserved.

Keywords

Hylan G-F 20, Osteoathritis, Knee, Economics, Cost and cost analysis, Health-related quality of life.

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Address correspondence to: Dr George Torrance, 1016-A Sutton Drive, Suite 200, Burlington, ON, Canada L7L 6B8. Tel: (905) 331 9911; Fax: (905) 331 9912; E-mail: [email protected]

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The Canadian Knee OA Study Group included the Steering Committee and clinical investigators. The Steering Committee consisted of J. P. Raynauld and G. W. Torrance, co-principal investigators; N. Bellamy, C. H. Goldsmith and P. Tugwell, co-investigators; P. A. Band, M. Schultz and V. Walker. The clinical investigators were: M. J. Bell, MD, Department of Medicine, University of Toronto, Toronto, ON; R. B. Bourne, MD, Department of Surgery, University of Western Ontario, London, ON; R. Cloutier, MD, Departement D'Orthopedie, Centre Hospitalier Affillie, Quebec, QC; A. M. Crawford, MB, Department of Medicine, University of Calgary, Calgary, AB; J. G. Cinats, Department of Surgery, University of Alberta Hospitals, Capital Health Regional Health Authority, Edmonton, AB; M.-A. Fitzcharles, MD, Department of Medicine, McGill University, Montreal, QC; R. D. Inman, MD, Division of Rheumatology, Toronto Western Hospital, University of Toronto, Toronto, ON; K. W. Marshall, MD, Division of Orthopaedics, Toronto Western Hospital, University of Toronto, Toronto, ON; D. P. O'Hanlon, MB, Department of Rheumatology, University of British Columbia, North Vancouver, BC; W. P. Olszynski, MD, Department of Medicine, University of Saskatchewan, Saskatoon, SK; J. Pope, MD, Department of Medicine, University of Western Ontario, London, ON; J.-P. Raynauld, MD, Department of Medicine, University of Montreal, QC; E. D. Sutton, MD, Department of Medicine, Dalhousie University, Halifax, NS; J. C. Thorne, MD, Department of Internal Medicine and Rheumatology, York County Hospital, Newmarket, ON.

Copyright © 2002 OsteoArthritis Research Society International. Published by Elsevier Ltd. All rights reserved.