Appropriate Use Criteria for Hyaluronic Acid in the Treatment of Knee Osteoarthritis in the United States

Author:

Bhadra Arup K.1,Altman Roy2,Dasa Vinod34,Myrick Karen56,Rosen Jeffrey78,Vad Vijay9,Vitanzo Peter10,Bruno Michelle11,Kleiner Hillary11,Just Caryn11

Affiliation:

1. Northeast Orthopedics and Sports Medicine, Airmont, NY, USA

2. Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA

3. LSU Health Sciences Center Department of Orthopaedics, New Orleans, LA, USA

4. LSU School of Medicine, New Orleans, LA, USA

5. Quinnipiac University School of Nursing, Joint Appointment Frank Netter School of Medicine, North Haven, CT, USA

6. Orthopedic Associates, Farmington, CT, USA

7. Department of Orthopaedics and Rehabilitation, New York-Presbyterian/Queens Hospital, New York, NY, USA

8. Weill Medical College of Cornell University, New York, NY, USA

9. Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA

10. Rothman Institute at Jefferson, Philadelphia, PA, USA

11. Avalere Health, Washington, DC, USA

Abstract

Objective: A workgroup of clinical experts has developed an Appropriate Use Criteria (AUC) for the use of hyaluronic acid (HA) in the treatment of osteoarthritis (OA) of the knee. The increasingly broad and varied use of HA injections, lack of published clinical guidance, and limited coverage for their use has created the imperative to establish appropriateness criteria. Methods: The experts of this workgroup represent rheumatology, orthopedic surgery, physiatry, sports medicine, and nursing clinicians with substantive knowledge of intra-articular HA therapy. This workgroup utilized the results of a systematic review of evidence, expert clinical opinion, and current evidence-based clinical practice guidelines to develop appropriateness criteria for the use of intra-articular HA for knee OA in 17 real-world clinical scenarios. Results: The workgroup scored the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as appropriate (7-9), uncertain (4-6), or inappropriate (1-3). Six scenarios were scored as appropriate, 10 scenarios were scored as uncertain, and 1 scenario was scored as inappropriate. Conclusion: This article can assist clinicians in shared decision-making by providing best practices in considering HA injections for knee OA treatment. Moreover, this AUC article can aid payers and policy makers in determining reimbursement and preauthorization policies and more appropriately managing health care resources. It is clear that further research is still necessary—particularly in patient populations differentiated by OA severity—that may benefit the greatest from the use of HA injections for the treatment of knee OA.

Funder

Advanced Medical Technology Association

Publisher

SAGE Publications

Subject

Physical Therapy, Sports Therapy and Rehabilitation,Biomedical Engineering,Immunology and Allergy

Reference84 articles.

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