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Hyaluronic acid/ Viscosupplementation for osteoarthritis of the knee was first reviewed by the HTA program in 2010.
- In 2013, the HCA director selected Hyaluronic acid/ Viscosupplementation for re-review based on a systematic review and meta-analysis (Rutjes 2012) that could change the original coverage determination.
- A rereview of Hyaluronic acid/ Viscosupplementation was completed later in 2013.
Hyaluronic acid preparations have been approved by the Food and Drug Administration (FDA) for treatment of pain associated with osteoarthritis (OA) of the knee in patients who have not had an adequate response to nonpharmacological, conservative treatment and simple analgesics. No new indications have been approved since the 2010 report.
Primary criteria ranking
- Safety = Medium
- Efficacy = Medium
- Cost = Medium
- Draft key questions - public comment and response
- Final key questions
- Draft report: public comment and response
- Final evidence report
- Final findings and decision
Assessment timeline (2013)
- Draft key questions published: March 21, 2013
- Public comment period: March 21 to April 8, 2013
- Draft report published: August 5, 2013
- Public comment period: August 5 to September 4, 2013
- Final report published: October 15, 2013
- HTCC Public meeting: November 15, 2013
Osteoarthritis (OA) is the most common form of chronic articular disease, and the most commonly affected joint is the knee. Conservative management generally requires a combination of both nonpharmacological and pharmacological therapies. Viscosupplementation, which involves an injection of hyaluronic acid, provides an alternative to NSAIDs and corticosteroid injection, both of which have potential undesirable side effects and/or other drawbacks. Hyaluronic acid is a normal component of synovial fluid and cartilage that acts as both a joint lubricant and a shock absorber. The concentration and molecular weight of endogenous hyaluronic acid are reduced in patients with osteoarthritic joints.