A Systematic Review on the Cost-Effectiveness of Intra-Articular Injections for Pain Relief in Symptomatic Patients with Osteoarthritis

Background: This systematic review aimed to assess the quality of published economic evaluations of ultrasound-guided intra-articular injections for symptomatic management of osteoarthritis, explore their scope and diversity, and determine their cost-effectiveness. Methods: Relevant electronic databases were systematically searched for studies published from January 2009 to June 2019. Keyword searches and Boolean operators were used to retrieve relevant literature. The PICOTS framework was utilized to define key research questions and guide the literature search. Duplicate removal, title and abstract screening were conducted to exclude irrelevant articles. Data from each study were extracted using a standardized form and summarized in an Excel spreadsheet. The SIGN quality appraisal tool for economic evaluations was employed to assess the quality of each study. Results: The initial database search yielded 238 articles, with 35 duplicates removed. Following title and abstract screening, an additional 198 articles were excluded due to not meeting the inclusion criteria. Full-text manuscripts of the remaining 5 articles were reviewed. Based on the quality appraisal, 4 out of the 5 studies were excluded. One study was not a primary study, one was still ongoing, and two were not economic evaluations. Due to the limited number of included studies, no subgroups were identified. Conclusions: This study provides evidence that ultrasound-guided intra-articular injections significantly improve clinical outcomes and enhance cost-effectiveness in the management of osteoarthritic joints. However, the scarcity of relevant studies highlights the need for further research to strengthen this finding.