Association Between Bio-Fermentation Derived Hyaluronic Acid and Healthcare Costs Following Knee Arthroplasty

Mathew Nicholls; Faizan Niazi; Winnie W Nelson; Edmund Lau; Steven M Kurtz; Kevin L Ong

doi:10.2147/CEOR.S347512

Association Between Bio-Fermentation Derived Hyaluronic Acid and Healthcare Costs Following Knee Arthroplasty

Clinicoecon Outcomes Res. 2022 Aug 30:14:575-585. doi: 10.2147/CEOR.S347512. eCollection 2022.

Authors

Mathew Nicholls¹, Faizan Niazi², Winnie W Nelson², Edmund Lau³, Steven M Kurtz⁴, Kevin L Ong⁴

Affiliations

¹ Virginia Mason Orthopaedics and Sports Medicine, Seattle, WA, USA.
² Ferring Pharmaceuticals Inc, Parsippany, NJ, USA.
³ Exponent, Inc, Menlo Park, CA, USA.
⁴ Exponent, Inc, Philadelphia, PA, USA.

Abstract

Background: Limiting access to intra-articular knee injections, including hyaluronic acid (HA), has been advocated as a cost-containment measure in the treatment of knee osteoarthritis. The association between presurgical injections and post-surgical complications such as early periprosthetic joint infection and revision remained to be investigated. This study evaluated pre- and post-surgical costs and rates of post-surgical complications in knee arthroplasty (KA) patients with or without prior HA use.

Methods: Commercial and Medicare Supplemental Claims Data (IBM MarketScan Research Databases) from January 1, 2012 to December 31, 2018 were used to identify unilateral KA patients. Those who completed a course of bio-fermentation derived HA (Bio-HA) as the first-line HA therapy comprised of the test group (n = 4091), while the control group did not use HA prior to KA (n = 118,659). Using multivariable regression with propensity score (PS) weighting, overall healthcare costs, readmission rates, and revision rates were assessed at six months following KA.

Results: Healthcare costs following KA were significantly lower for the Bio-HA group ($10,021 ± $22,796) than No HA group ($12,724 ± $32,966; PS p < 0.001). Bio-HA patients had lower readmission rates (8.9% vs 14.0%; PS p < 0.001) and inpatient costs per readmitted patient ($43,846 ± $50,648 vs $50,533 ± $66,150; PS p = 0.005). There were no differences in revision rate for any reason (Bio-HA: 0.78% vs No HA: 0.67%; PS p = 0.361) and with PJI (Bio-HA: 0.42% vs No HA: 0.33%; PS p = 0.192). Costs in the six months up to and including the KA were similar for both groups (Bio-HA: $49,759 ± $40,363 vs No HA: $50,532 ± $43,183; PS p = 0.293).

Conclusion: Bio-HA use prior to knee arthroplasty did not appear to increase overall healthcare costs in the six months before and after surgery. Allowing access to HA injections provides a non-surgical therapeutic option without increasing cost or risk of post-surgical complications.

Keywords: bio-fermentation derived hyaluronic acid; healthcare costs; intra-articular hyaluronic acid; knee arthroplasty; readmissions.

Grants and funding

Exponent, Inc. received funding from Ferring Pharmaceuticals Inc. for this study. Two of the authors (FN, WNN) are employees of the study sponsor and were involved in the design of the study, interpretation of data, critical revision of the manuscript, and the decision to submit the report for publication. The study sponsor was not involved in the initial collection and analysis of the data.