Hyaluronic Acid Injections for Knee Osteoarthritis

Kevin Zhu, A. Acuña, Linsen T Samuel, Daniel Grits, A. Kamath
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引用次数: 4

Abstract

Background: The utilization of hyaluronic acid (HA) for the management of knee osteoarthritis (OA) remains controversial, and more information is needed regarding how its utilization and financial burden have changed over recent years. The purpose of our analysis was to evaluate changes in overall utilization and health-care costs associated with HA injections among Medicare beneficiaries over a contemporary time frame. Methods: The 2012 to 2018 Medicare Fee-for-Service Provider Utilization and Payment Public Use Files (PUFs) were utilized for our analysis. Organized by Healthcare Common Procedure Coding System (HCPCS) codes, these files capture 100% of Medicare Part B claims. Payment and utilization data were collected for all HCPCS codes corresponding to injection of an HA formulation. The number of services involving HA as well as the total cost of HA administration in 2020 U.S. dollars were tabulated. Mann-Kendall trend tests were used to evaluate trends in utilization for providers nationally and when segregated by specialty. Results: Total HA utilization increased significantly from 2012 (n = 1,090,503) through 2018 (n = 1,209,489; p = 0.04). Although orthopaedic surgeons did not demonstrate significant changes in total utilization rates (p = 0.23), the average number of services per orthopaedic surgeon increased significantly (p = 0.02). Reflecting a substantial growth in the number of advanced practice providers (APPs) providing injections, there was a significant increase in utilization and associated costs among physician assistants (p < 0.01) and nurse practitioners (p < 0.01). Total costs associated with HA services increased significantly from $290.10 million to $325.02 million (p < 0.01). Conclusions: Despite the 2013 American Academy of Orthopaedic Surgeons clinical practice guideline recommending against the clinical utility of these injections, HA services continued to be widely implemented among Medicare beneficiaries. Although there were variations across specialties when evaluating overall utilization rates as well as rates per provider, APPs largely contributed to the increase seen in the U.S. over this study period. More data are needed to support continued implementation and spending on this low-value care.
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透明质酸注射治疗膝骨关节炎
背景:透明质酸(HA)在膝关节骨关节炎(OA)治疗中的应用仍存在争议,需要更多的信息来了解近年来其应用和经济负担的变化。我们分析的目的是评估当代医疗保险受益人中与HA注射相关的总体利用率和医疗保健成本的变化。方法:利用2012 - 2018年医疗保险服务提供者收费使用和支付公共用途文件(PUFs)进行分析。由医疗保健通用程序编码系统(HCPCS)代码组织,这些文件捕获100%的医疗保险B部分索赔。收集所有HCPCS代码与注射一种HA制剂相对应的支付和使用数据。以2020年计,涉及医管局的服务数目及医管局管理总成本以美元计。使用Mann-Kendall趋势检验来评估全国和按专业区分的提供者的使用趋势。结果:从2012年(n = 1,090,503)到2018年(n = 1,209,489;P = 0.04)。尽管骨科医生的总使用率没有显著变化(p = 0.23),但每位骨科医生的平均服务次数显著增加(p = 0.02)。医师助理(p < 0.01)和执业护士(p < 0.01)的使用率和相关成本显著增加,反映了提供注射服务的高级执业人员(app)数量的大幅增长。医管局服务的总成本由290.10万元大幅增加至32502万元(p < 0.01)。结论:尽管2013年美国骨科医师学会临床实践指南不推荐这些注射的临床应用,HA服务继续在医疗保险受益人中广泛实施。尽管在评估整体使用率和每个供应商的使用率时,不同专业之间存在差异,但在本研究期间,应用程序对美国的增长做出了很大贡献。需要更多的数据来支持这种低价值护理的持续实施和支出。
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