A cost-minimization analysis of MD-Knee versus hyaluronic acid in patients with knee osteoarthritis

Analisi di minimizzazione dei costi di MD-Knee rispetto all’acido ialuronico nel trattamento di pazienti con osteoartrosi del ginocchio


  • Alberto Migliore Operative Unit of Rheumatology “S. Pietro Fatebenefratelli” Hospital, Roma - Italy
  • Roberto Ravasio Health Publishing and Services, Milano - Italy




Cost, Hyaluronic acid, Italian NHS, MD-Knee, SUPARTZ


Introduction: The administration by injection of hyaluronic acid (HA) for 3-5 weeks is effective in the treatment of patients with knee osteoarthritis (OA). Other products for intra-articular use have been recently introduced for the treatment of OA. Among these, a medical device, MD-Knee, produced by Guna S.p.A.; this study aims to estimate the cost-minimization of MD-Knee versus HA in the treatment of knee osteoarthritis.

Methods and Results: We performed a cost-minimization analysis (CMA). The CMA was conducted from the perspective of the Italian National Health Service (iNHS). Only direct medical costs (MD-Knee and HA) were considered. We performed a sensitivity analysis to test the robustness of the results. The mean 6-months cost per patient was € 75,00 with MD-Knee and € 185,00 with HA.

Conclusion: From the Italian National Health Service’s perspective, MD-Knee appears to be the cost-saving therapeutic option compared with HA in the treatment of patients with knee osteoarthritis. (HTA & Market Access)


Linda Fernandes, Kåre B Hagen, Johannes W J Bijlsma, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis. 2013;72:1125-35.

Kloppenburg M, Berenbaum F. Osteoarthritis year in review 2019: epidemiology and therapy. Osteoarthritis Cartilage. 2020;28(3):242-8.

Sebbag E, Felten R, Sagez F, Sibilia J, Devilliers H, Arnaud L. The world-wide burden of musculoskeletal diseases: a systematic analysis of the World Health Organization Burden of Diseases Database. Ann Rheum Dis. 2019;78(6):844-8.

Kluzek S, Sanchez-Santos MT, Leyland KM, et al. Painful knee but not hand osteoarthritis is an independent predictor of mortality over 23 years follow-up of a population-based cohort of middle-aged women. Ann Rheum Dis. 2016;75(10):1749-56.

Cleveland RJ, Alvarez C, Schwartz TA, et al. The impact of painful knee osteoarthritis on mortality: a community-based cohort study with over 24 years of follow-up. Osteoarthritis Cartilage. 2019;27(4):593-602.

Corsi M, Alvarez C, Callahan LF, et al. Contributions of symptomatic osteoarthritis and physical function to incident cardiovascular disease. BMC Muscoskelet Disord. 2018;19(1):393.

Turkiewicz A, Kiadaliri AA, Englund M. Cause-specific mortality in osteoarthritis of peripheral joints. Osteoarthritis Cartilage. 2019;27(6):848-54.

Hawker GA, Croxford R, Bierman AS, et al. All-cause mortality and serious cardiovascular events in people with hip and knee osteoarthritis: a population based cohort study. PLoS One. 2014;9(3):e91286.

OARSI. Osteoarthritis: A Serious Disease, Submitted to the U.S. Food and Drug Administration. December 1, 2016. https://www.oarsi.org/sites/default/files/library/2018/pdf/oarsi_white_paper_oa_serious_disease121416_1.pdf.

Conrozier T, Monfort J, Chevalier X, et al. EUROVISCO Recommendations for Optimizing the Clinical Results of Viscosupplementation. Osteoarthritis Cartilage. 2020;11(1):47-59. Epub 2018 Jun 21.

Raman R, Henrotin Y, Chevalier X, et al. Decision Algorithms for the Retreatment with Viscosupplementation in Patients Suffering from Knee Osteoarthritis: Recommendations from the EUROpean VIScosupplementation COnsensus Group (EUROVISCO). Cartilage. 2018;9(3):263-75.

Cooper C, Rannou F, Richette P, et al. Use of Intraarticular Hyaluronic Acid in the Management of Knee Osteoarthritis in Clinical Practice. Arthritis Care Res (Hoboken). 2017;69(9):1287-96.

Paoloni M, Bernetti A, Belelli A, et al. Appropriateness of clinical and organizational criteria for intra-articular injection therapies in osteoarthritis. A Delphi method consensus initiative among experts in Italy. Ann Ist Super Sanita. 2015;51(2):131-8.

Bruyère O, Honvo G, Veronese N, et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum. 2019;49(3):337-50.

Trojian TH, Concoff AL, Joy SM, Hatzenbuehler JR, Saulsberry WJ, Coleman CI. AMSSM scientific statement concerning viscosupplementation injections for knee osteoarthritis: importance for individual patient outcomes. Br J Sports Med. 2016;50(2):84-92.

Broadbent J, Maisey S, Holland R, et al. Recorded quality of primary care for osteoarthritis: an obervational study. Br J Gen Pract. 2008;58:839-43.

Snijders GF, den Broeder AA, van Riel PLCM, et al. Evidence-based tailored conservative treatment of knee and hip osteoarthritis: between knowing and doing. Scand J Rheumatol. 2011;40:225-31.

Conaghan PG, Arden N, Avouac B, Migliore A, Rizzoli R. Safety of Paracetamol in Osteoarthritis: What Does the Literature Say? Drugs Aging. 2019;36(Suppl. 1):7-14.

Ruiu DE. Medical Device iniettabili a base di collagene. Stato dell’arte e overview degli studi clinici. Advanced Therapies. Numero 1. 2012.

Maheu E, Bannuru RR, Herrero-Beaumont G, Allali F, Bard H, Migliore A. Why we should definitely include intra-articular hyaluronic acid as a therapeutic option in the management of knee osteoarthritis: Results of an extensive critical literature review. Semin Arthritis Rheum. 2019;48(4):563-72.

Cooper C, Rannou F, Richette P, et al. Use of Intraarticular Hyaluronic Acid in the Management of Knee Osteoarthritis in Clinical Practice. Arthritis Care Res (Hoboken). 2017;69(9):1287-96.

Martin LSM, Massafra U, Bizzi E, Migliore A. A double blind randomized active controlled clinical trial on the intra-articular use of Md-Knee versus sodium hyaluronate in patients with knee osteoarthritis (“Joint”). BMC Musculoskelet Disord. 2016;17:94.

Di Cesare ML, Micheli L, Zanardelli M, Ghelardini C. Low dose native type II collagen prevents pain in a rat osteoarthritis model. BMC Musculoskelet Disord. 2013;14:228.

Naraoka T, Ishibashi Y, Tsuda E, Yamamoto Y, Kusumi T, Toh S. Periodic knee injections of collagen tripeptide delay cartilage degeneration in rabbit experimental osteoarthritis. Arthritis Res Ther. 2013;15(1):R32.

Xiao D, Hu J, Chen K, Man C, Zhu S. Protection of articular cartilage by intra-articular injection of NEL-like molecule 1 in temporomandibular joint osteoarthritis. J Craniofac Surg. 2012;23(1):e55-8.

Milani L. Un nuovo e raffinato trattamento iniettivo delle patologie algiche dell’Apparato locomotore. Le proprietà bio-scaffold del collagene e suo utilizzo clinico. La Med Biol. 2010;3:3-15.

Pham T, van der Heijde D, Altman RD, et al. OMERACT-OARSI initiative: osteoarthritis research society international set of responder criteria for osteoarthritis clinical trials revisited. Osteoarthr Cartil. 2004;12(5):389-99.

Gruppo di lavoro AIES (coordinato da G. Fattore). Proposta di Linee Guida per la valutazione economica degli interventi sanitari in Italia. PharmacoEconomics-Italian Research Articles. 2009;11:83-93.



How to Cite

Migliore A, Ravasio R. A cost-minimization analysis of MD-Knee versus hyaluronic acid in patients with knee osteoarthritis: Analisi di minimizzazione dei costi di MD-Knee rispetto all’acido ialuronico nel trattamento di pazienti con osteoartrosi del ginocchio. AboutOpen [Internet]. 2020 Jun. 12 [cited 2023 Sep. 28];7(1):16-20. Available from: https://journals.aboutscience.eu/index.php/aboutopen/article/view/2141
Received 2020-05-05
Accepted 2020-05-20
Published 2020-06-12

Most read articles by the same author(s)