Limiting treatment to those recommended by the American Academy of Orthopaedic Surgeon Clinical Practice Guidelines has been suggested to decrease costs by 45% in the year prior to total knee arthroplasty, but this only focuses on expenditures leading up to, but not including, the surgery and not the entire episode of care. We evaluated the treatment costs following knee osteoarthritis (OA) diagnosis and determined whether these are different for patients who use intra-articular hyaluronic acid (HA) and/or knee arthroplasty. Claims data from a large commercial database containing de-identified data of more than 100 million patients with continuous coverage from 2012 to 2016 was used to evaluate the cumulative cost of care for over 2 million de-identified members with knee OA over a 4.5-year period between 2011 and 2015. Median cumulative costs were then stratified for patients with or without HA and/or knee arthroplasty. Knee OA treatment costs for 1,567,024 patients over the 4.5-year period was $6.60 billion (mean $4210/patient) as calculated by the authors. HA and knee arthroplasty accounted for 3.0 and 61.5% of the overall costs, respectively. For patients who underwent knee arthroplasty, a spike in median costs occurred sooner for patients without HA use (around the 5- to 6-month time point) compared to patients treated with HA (around the 16- to 17-month time point). Non-arthroplasty therapies, as calculated by the authors, accounted for about one third of the costs in treating knee OA in our cohort. Although some have theorized that limiting the use of HA may reduce the costs of OA treatment, HA only comprised a small fraction (3%) of the overall costs. Among patients who underwent knee arthroplasty, those treated with HA experienced elevated costs from the surgery later than those without HA, which reflects their longer time to undergoing knee arthroplasty. The ability to delay or avoid knee arthroplasty altogether can have a substantial impact on the cost to the healthcare system.

中文翻译：

---

透明质酸和膝关节置换术的膝关节 OA 成本比较。

建议将治疗限制在美国骨科医师学会临床实践指南推荐的治疗范围内，这样可以在全膝关节置换术前一年将费用降低 45%，但这仅侧重于但不包括手术和手术之前的支出。不是整个护理过程。我们评估了膝骨关节炎 (OA) 诊断后的治疗费用，并确定这些费用对于使用关节内透明质酸 (HA) 和/或膝关节置换术的患者是否有所不同。使用来自大型商业数据库的索赔数据，该数据库包含 2012 年至 2016 年持续承保的超过 1 亿名患者的去识别化数据，用于评估超过 200 万膝关节 OA 去识别化会员在 4.5 年内的累计护理费用2011 年至 2015 年期间。然后对接受或不接受 HA 和/或膝关节置换术的患者的中位累积成本进行分层。根据作者的计算，4.5 年期间 1,567,024 名患者的膝关节 OA 治疗费用为 66 亿美元（平均每位患者 4210 美元）。HA 和膝关节置换术分别占总费用的 3.0% 和 61.5%。对于接受膝关节置换术的患者来说，与接受 HA 治疗的患者（大约 16 至 17 个月的时间点）相比，未使用 HA 的患者（大约 5 至 6 个月的时间点）的中位成本高峰出现得更早。根据作者的计算，非关节成形术治疗约占我们队列中治疗膝骨关节炎费用的三分之一。尽管一些人认为限制 HA 的使用可能会降低 OA 治疗的成本，但 HA 只占总成本的一小部分 (3%)。在接受膝关节置换术的患者中，接受HA治疗的患者比未接受HA治疗的患者的手术费用更高，这反映出他们接受膝关节置换术的时间更长。延迟或完全避免膝关节置换术的能力可能会对医疗保健系统的成本产生重大影响。