{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T21:40:56Z","timestamp":1791495656522,"version":"4.3.4"},"reference-count":91,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9,16]]},"abstract":"\n Background:<\/jats:title>\n Use of platelet-rich-plasma (PRP) injections for treating knee osteoarthritis has increased over the past decade. We used cost-effectiveness analysis to evaluate the value of PRP in delaying the need for total knee arthroplasty (TKA).<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n We developed a Markov model to analyze the baseline case: a 55-year-old patient with Kellgren-Lawrence grade-II or III knee osteoarthritis undergoing a series of 3 PRP injections with a 1-year delay to TKA versus a TKA from the outset. Both health-care payer and societal perspectives were included. Transition probabilities were derived from systematic review of 72 studies, quality-of-life (QOL) values from the Tufts University Cost-Effectiveness Analysis Registry, and individual costs from Medicare reimbursement schedules. Primary outcome measures were total costs and quality-adjusted life years (QALYs), organized into incremental cost-effectiveness ratios (ICERs) and evaluated against willingness-to-pay thresholds of $50,000 and $100,000. One and 2-way sensitivity analyses were performed as well as a probabilistic analysis varying PRP-injection cost, TKA delay intervals, and TKA outcomes over 10,000 different simulations.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n From a health-care payer perspective, PRP resulted in 14.55 QALYs compared with 14.63 for TKA from the outset, with total health-care costs of $26,619 and $26,235, respectively. TKA from the outset produced a higher number of QALYs at a lower cost, so it dominated. From a societal perspective, PRP cost $49,090 versus $49,424 for TKA from the outset. The ICER for TKA from the outset was $4,175 per QALY, below the $50,000 willingness-to-pay threshold. Assuming the $728 published cost of a PRP injection, no delay time that was <10 years produced a cost-effective course. When the QOL value was increased from the published value of 0.788 to >0.89, PRP therapy was cost-effective with even a 1-year delay to TKA.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n When considering direct and unpaid indirect costs, PRP injections are not cost-effective. The primary factor preventing PRP from being cost-effective is not the price per injection but rather a lack of established clinical efficacy in relieving pain and improving function and in delaying TKA. PRP may have value for higher-risk patients with high perioperative complication rates, higher TKA revision rates, or poorer postoperative outcomes.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Economic\n Level IV<\/jats:underline>\n . See Instructions for Authors for a complete description of levels of evidence.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.19.01446","type":"journal-article","created":{"date-parts":[[2020,5,21]],"date-time":"2020-05-21T23:30:58Z","timestamp":1590103858000},"page":"e104","source":"Crossref","is-referenced-by-count":53,"title":["The Cost-Effectiveness of Platelet-Rich Plasma Injections for Knee Osteoarthritis"],"prefix":"10.2106","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9639-9022","authenticated-orcid":false,"given":"Prashant V.","family":"Rajan","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5831-055X","authenticated-orcid":false,"given":"Mitchell K.","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2755-0742","authenticated-orcid":false,"given":"Alison","family":"Klika","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9214-2756","authenticated-orcid":false,"given":"Atul F.","family":"Kamath","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0851-8352","authenticated-orcid":false,"given":"George F.","family":"Muschler","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9143-2455","authenticated-orcid":false,"given":"Carlos A.","family":"Higuera","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3007-7538","authenticated-orcid":false,"given":"Nicolas S.","family":"Piuzzi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,5,22]]},"reference":[{"issue":"7","key":"bib1-20230810","article-title":"Platelet-rich plasma for the treatment of knee osteoarthritis: a review","volume":"30","author":"Piuzzi","year":"2017","journal-title":"J Knee Surg."},{"issue":"1","key":"bib3-20230810","article-title":"Intraarticular injections of platelet-rich plasma (PRP) in the management of knee osteoarthritis","volume":"1","author":"Rodriguez-Merchan","year":"2013","journal-title":"Arch Bone Jt Surg."},{"issue":"12","key":"bib4-20230810","doi-asserted-by":"crossref","DOI":"10.1038\/nrrheum.2013.141","article-title":"Platelet-rich plasma for managing pain and inflammation in osteoarthritis","volume":"9","author":"Andia","year":"2013","journal-title":"Nat Rev Rheumatol."},{"issue":"3","key":"bib5-20230810","doi-asserted-by":"crossref","DOI":"10.1097\/JSM.0b013e31827c3846","article-title":"Clinical and MRI outcomes after platelet-rich plasma treatment for knee osteoarthritis","volume":"23","author":"Halpern","year":"2013","journal-title":"Clin J Sport Med."},{"issue":"10","key":"bib6-20230810","doi-asserted-by":"crossref","DOI":"10.1136\/bjsports-2014-094036","article-title":"Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis","volume":"49","author":"Laudy","year":"2015","journal-title":"Br J Sports Med."},{"issue":"3","key":"bib7-20230810","doi-asserted-by":"crossref","DOI":"10.1016\/j.arthro.2015.08.005","article-title":"Efficacy of intra-articular platelet-rich plasma injections in knee osteoarthritis: a systematic review","volume":"32","author":"Meheux","year":"2016","journal-title":"Arthroscopy."},{"issue":"11","key":"bib8-20230810","doi-asserted-by":"crossref","DOI":"10.1016\/j.arthro.2015.03.041","article-title":"Does intra-articular platelet-rich plasma injection provide clinically superior outcomes compared with other therapies in the treatment of knee osteoarthritis? 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