Recent production / Viscosupplementation for the Treatment of Osteoarthritis of the Knee

2007-07-26@ 09:30:00

Report prepared for AETMIS by Pierre Dagenais and Alicia Framarin.

Osteoarthritis of the knee is a degenerative disease that frequently results in the need for total knee replacement. This disease has been absorbing an ever-growing share of the human and financial resources of Québec's health-care system.

Considered by some to be an alternative to surgery, viscosupplementation involves draining the affected knee then injecting it with hyaluronic acid. The clinical effectiveness of this procedure, which is intended to relieve pain and improve joint mobility, remains controversial.

After examining a series of meta-analyses and assessments reports on the different types of viscosupplements available, we concluded that viscosupplementation offers clinically modest relief from the symptoms of knee OA over a period that could last up to several weeks. It is furthermore a safe short-term treatment. Of note, these conclusion are based on secondary analyses of a multitude of small primary studies of poor methodological quality.

Available data did not help distinguish differences in the effectiveness of any one product over the others. It was equally impossible to identify patient subgroups more likely to benefit from this treatment compared with other current ly available therapeutic modalities.

The cost-effectiveness of this treatment could not be established owing to discrepancies among the clinical data used and the methodological limitations of the economic studies examined. Funding this treatment would lead to a cost increase of some ten millions of dollars per year and would command significant professional resources at a time when the health system is experiencing a labour shortage.

Consequently, AETMIS considers that, given the modest effectiveness of this therapeutic treatment compared with its relatively high cost and the additional professional resources required to administer it, it is not currently justified to contemplate funding viscosupplementation for all patients with OA of the knee.

It nonetheless raises the possibility that this product could be offered as a last-resort treatment to patients who do not achieve pain relief from conventional therapies or for whom these are contraindicated.

The recommendations not to cover this treatment does not exclude the fact that the Ministry of Health and Social Services may examine the possibility of exceptionally offering it to people who have failed to achieve pain relief from recognized conventional treatments, as do some other third-party payers.

AETMIS therefore recommends that granting agencies should encourage universities to pursue clinical research on viscosupplementation as part of the research areas or programs dedicated to musculoskeletal diseases and focused on either osteoarthritis or chronic pain.