Using Medicare data to understand low-value health care: the case of intra-articular hyaluronic acid injections.

UsingMedicare Data to Understand Low-Value Health Care: The Case of Intra-articular Hyaluronic Acid Injections The US Food and Drug Administration first approved intraarticularhyaluronicacid injections (alsoknownasviscosupplementation) in 1997 to treat patients with severe knee osteoarthritis. The effectiveness of these injections, however, has recently been questioned. In 2013, the American Academy of Orthopedic Surgeons issued a clinical practice guideline that stated, “We cannot recommend using hyaluronic acid for patients with symptomatic [osteoarthritis] of the knee,” with a “strong” rating.1 The rating was based on high-quality evidence that hyaluronic acid injectionswerenot associatedwith clinicallymeaningful improvementinsymptomscomparedwith placebo injections. A meta-analysis published in 2012 reported similar findings.2 Using recent Medicare Part B claims data, we examined patterns of use for intra-articular hyaluronic acid injections across the United States.