Cost effectiveness of two-stage algorithm (prolotherapy injections prior to total knee arthroplasty) in the management of advanced stage knee osteoarthritis in the geriatric population

Abstract

The aim of the present study was to evaluate the cost effectiveness of prolotherapy injections (PrT) combined with rehabilitation protocol (RP) prior to total knee arthroplasty (TKA)) in the management of knee osteoarthritis in the geriatric population.

Patients were divided into two groups as two-stage algorithm (PrT combined with RP prior to TKA), (Group A, n=98) and one-stage (TKA),(Group B, n=99). Clinical effectiveness was evaluated via Visual Analog Scale (VAS), The Western Ontario and McMaster Universities Arthritis Index (WOMAC) at baseline and 3-, 6-, 12-, and 18-month follow-ups. Cost–utility per quality-adjusted life years (QALY) and Incremental cost-effectiveness ratios (ICERs) of each group were calculated.

Patients in both group had better outcomes in terms of pain relief and knee functions at 18-month follow-ups (p?0.001). Group A had better WOMAC and VAS scores at three- and six-month follow-ups compared to Group B, while Group B had better scores at 12-month follow-ups. Both scores were not significantly different at 18-month follow-ups. Group A had the most favorable cost/QALY gain ratio ($2,968.26/QALY) compared to Group B ($5,785.52/ QALY).

Both methods are efficacious and safe in treating knee osteoarthritis. However, two-stage treatment (PrT combined with RP prior to TKA) offers advantages of less cost and higher cost-effectiveness.