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Comment & Response
March 2015

Using Medicare Data to Understand Health Care Value—Reply

Author Affiliations
  • 1Department of Medicine/Rheumatology, University of California, San Francisco
  • 2San Francisco Veterans Affairs (VA) Medical Center, San Francisco, California
  • 3Philip R. Lee Institute for Health Policy Studies, Department of Orthopedic Surgery, University of California, San Francisco
JAMA Intern Med. 2015;175(3):462-463. doi:10.1001/jamainternmed.2014.7194

In Reply We disagree with Band; our analysis of intra-articular hyaluronic acid injections for knee osteoarthritis in the Medicare program does not have conceptual errors.1 Our analysis accurately presented the utilization of this procedure, including clinician and regional variation.

The American Academy of Orthopaedic Surgeons (AAOS) is among the many organizations that recommend against the use of this procedure, including the United Kingdom’s National Institute for Health and Care Excellence and a group of independent investigators who performed a systematic review and meta-analysis.2,3 The meta-analysis performed by the AAOS of hyaluronic acid studies showed that among high-quality studies, there was no clinically significant difference between hyaluronic acid and sham injection groups. Although some individual studies reported differences that were statistically significant, others reported conflicting results or found no differences, and the aggregate differences were not statistically significant. The AAOS did not deliberately exclude effectiveness studies from its analysis; to our knowledge, no high-quality effectiveness trials exist. Finally, multiple studies have found publication bias and conflicts of interest among hyaluronic acid studies.3,4

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