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Comment & Response |

Using Medicare Data to Understand Health Care Value—Reply

Gabriela Schmajuk, MD, MS1,2; Kevin J. Bozic, MD, MBA3; Jinoos Yazdany, MD, MPH1
[+] 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.
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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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March 1, 2015
Philip A. Band, PhD
1Department of Orthopaedic Surgery, New York University School of Medicine, New York2Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, New York
JAMA Intern Med. 2015;175(3):462. doi:10.1001/jamainternmed.2014.7189.
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