Zur Kostenwirksamkeit einer konservativen Gonarthrose-Therapie

Zusammenfassung

Studienziel: Vergleich der klinischen und gesundheitsökonomischen Datenlage bei intraartikulärer Hyaluronsäuretherapie (Hyalart) bzw. „Standard“-Therapie der Gonarthrose.

Methodik: Prospektive Beobachtungsstudie von 179 Patienten in 5 orthopädischen Fachpraxen. Beurteilung der Lebensqualität durch Lequeme-Index und Euroquol-Skala.

Ergebnisse: Nach intraartikulärer Hyalarttherapie kommt es zu größeren Verbesserungen der Lebensqualität als bei Standardbehandlung. Bei der Kostenanalyse ergeben sich deutliche Einsparungen für die Hyaluronsäuretherapie, die durch die Kosten für die Hyalartmedikation kompensiert werden.

Schlußfolgerungen: Die intraartikuläre Therapie mit Hyaluronsäure (Hyalart) führt klinisch zu besseren Ergebnissen als eine Standardtherapie der Gonarthrose und - unter derzeitigen Bedingungen - zu keinen wesentlichen Mehrkosten.

Abstract

Hyaluronic acid (HYA) recently in several clinical studies has been shown to reduce gonarthrotic pain and to improve mobility. As an outcome measure usually the medical judgement and/or patient satisfaction as well as the Lequesne-index or the Euroquol index were used. The objective of this study was to investigate the cost-effectiveness (CEA) of HYA in a German ambulatory setting.

Methods: In 5 orthopedic specialist's practices a total of 179 patients with gonarthrosis habe been evaluated, 90 under treatment with HYA, 89 with standard treatment (SDT). After 6 months the effects of HYA as measured by the Lequesne- and Euroquol-indices have been compared to SDT and analysed for cost of treatment.

Results: All index values for pain and mobility show - mostly significant - differences in favour of HYA, e.g. 92.4% of all patients under HYA achieved optimum values of Euroquol for general satisfaction vs. 42.9% in the reference group. The direct medical costs of 796,11 DM are higher for HYA by 286,85 DM (incl. 649 for HYA alone): the cost of medical services are lower by 108 DM, for lost days of work they are lower by 98 DM as compared to SDT. The average cost-effectiveness of HYA was superior for the effects on pain and mobility (e.g. differences of 978 and 328 DM resp. in direct costs), how-ever, indifferent for the complete indices. also marginal cost-effectiveness shows mainly favourable results for the various outcome-dimensions of quality of life used, the values being partly lower than the average cost-effectiveness.

Discussion: HYA shows mainly superior effects on quality of life as compared so SDT. Savings occur mainly with the regard to additive therapies and loss of work days. Overall HYA therapy is not more expensive but more beneficial than SDT.

Schlüsselwörter

Gonarthrose - konservative Behandlung - Hyaluronsäure - Kostenwirksamkeit

Key words

Gonarthrosis - hyaluronic acid - ost-effectiveness