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Overview of Appropriate Use Criteria for Treating Knee Osteoarthritis

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Earlier this year, Avalere led a work group of rheumatology, orthopedic surgery, psychiatry, sports medicine, and primary care clinicians to develop appropriate use criteria for the use of hyaluronic acid (HA) in the treatment of knee osteoarthritis (OA).

Appropriate use criteria specify when it is appropriate to perform a procedure, and facilitate clinical decision-making, by combining the best available scientific evidence with the collective judgment of physicians to determine the appropriateness of performing that procedure. The increasingly broad and varied use of HA injections, lack of published clinical guidance, and limited coverage for their use has led to the need to establish appropriateness criteria. This work group utilized the results of a systematic review of evidence, expert clinical opinion, and current evidence-based clinical practice guidelines to develop appropriateness criteria for the use of intra-articular HA for knee OA in 17 real-world clinical scenarios.

The appropriate use criteria document was recently published in the journal Cartilage.

As an output of this research, the work group scored the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as appropriate (7–9), uncertain (4–6), or inappropriate (1–3). Six scenarios were scored as appropriate, 10 scenarios were scored as uncertain, and 1 scenario was scored as inappropriate.

This article can assist clinicians in shared decision-making by providing best practices in considering HA injections for knee OA treatment. Moreover, the AUC can aid payers and policy makers in determining reimbursement and preauthorization policies and more appropriately managing healthcare resources. It is clear that further research is still necessary-particularly in patient populations differentiated by OA severity-that may benefit the greatest from the use of HA injections for the treatment of knee OA.

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