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| |  DG DISPATCH - AAOS: Hylan G-F 20 Injections Clinically And Cost-Effective For Knee Osteoarthritis By Cameron Johnston Special to DG News
SAN FRANCISCO, CA -- March 2, 2001 -- An important study by investigators in Canada has shown that intra-articular injections of the viscous supplement, Hylan G-F 20, (Synvisc, Wyeth Ayerst Laboratories and Genzyme Biosurgery), is not only effective in treating osteoarthritis of the knee, but it also is cost-effective. The study, headed by Dr. Nicholas Bellamy, a rheumatologist now at the University of Queensland, in Australia, and formerly of McMaster University, in Hamilton, Canada, was presented yesterday (March 1) at the annual meeting of the American Academy of Orthopedic Surgeons here. In the study, which was designed to mimic real life conditions, 127 patients over the age of 40 with osteoarthritis of the knee were chosen to receive the supplement, which is administered through three injections over a two- to three-week period. The subjects were compared with a cohort of age and demographically matched patients who received what is known as appropriate care as defined by the American College of Rheumatology. They continued using non-steroidal anti-inflammatory drugs such as acetaminophen, other analgesics such as aspirin, and other methods of knee pain relief. All of the subjects had suffered from osteoarthritis of the knee for at least nine years, and four out of five had it in both knees. Prior to the start of the study, approximately one-third of the subjects in each group had had some form of surgery for the condition. None had received corticosteroid injections within three months of being enrolled in the study. At the end of the one-year study, those who had received Hylan plus appropriate care reported Western Ontario and McMaster Universities (WOMAC) scores which were 25.07 percent lower than those who had received only appropriate care. The WOMAC scoring system was developed to measure a patient’s pain and suffering specifically caused by osteoarthritis of the knee, and is now used worldwide. Furthermore, 29 percent of those in the Hylan group reported improvements of greater than 20 percent on the pain scale, and 27 percent had improvements of greater than 20 percent on either the pain, physical function or stiffness scale. According to a patient global assessment of improvement scale, 46 percent more patients being treated with Hylan had marked improvements in the problem knee as compared with those in the appropriate care group. Furthermore, 21 percent more Hylan patients reported marked improvements in the contra-lateral knee, and 22 percent had significant improvements in overall health compared to the control group. Dr. Bellamy said the patients reported improvement in the contra-lateral knee because their overall health improved and that left them feeling more positive and able to engage in more activities of daily living. "This data isn’t just clinically relevant, it’s statistically significant," he said. A measurement known as the Health Utility Index, which evaluates the cost-effectiveness of a particular treatment, showed that the cost per quality adjusted life year (QALY) gained was $10,000 CAN, meaning the cost to the individual and to the healthcare system was justified in this case, Dr. Bellamy explained. He stressed that the $10,000 figure does not represent the cost of the drug or the treatment, but is a figure calculated by health-care economists to express a "cost-utility ratio". The drug itself costs approximately $565 US per course of treatments, which involves three separate injections over a two- to three-week period. "This data tells us that not only is the drug effective, but it is cost-effective. The cost per QALY gained is strong evidence in favor of this drug’s adoption and more widespread use," Dr. Bellamy said.
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