Discussion
knee osteoarthritis, OA, chronic progressive disease
DISEASE, KNEE OSTEOARTHRITIS, MEDICAL COMPLICATION
Knee OA is a chronic progressive disease in nature and pre-existing nonsurgical treatments have not yet been proven as a curative treatment for this disease. In advanced cases, joint replacement surgery is the gold standard treatment. Therefore, considering the medical complications of such major surgeries, as well as the financial burden of a long recovery period and the need for rehabilitation has led to an increased effort to find alternative treatments. Up to now, several intra-articular injections, such as PRP, PRGF, HA, and Ozone have proven their effectiveness in numerous clinical trial articles and systematic reviews [In recent years, a majority of studies have focused on comparing the effectiveness of injectable and non-injectable interventions regarding knee OA treatment [The study results revealed that among intra-articular injections for knee osteoarthritis treatment, PRP, in comparison to PRGF, HA, and Ozone, by acquisition of the most ICER (7583.16), is the most cost-effective injection. In addition, regarding the net monetary benefit, PRP was reported as the best intervention with the highest net monetary benefit (6385.40$). Moreover, based on the sensitivity analysis results, the acceptability of PRP and PRGF, and the probability of efficacy of PRP and PRGF were the most important variables affecting the outcomes of the study (Fig. The current results are reasonable due to the economic conditions in Iran. High molecular weight HA, used in the original study, was Hyalgan, an importable drug without the cover of insurance, that by considering the lower value of the national currency of Iran, would be an expensive drug (180$), however during last years the preparation kits of PRP as well as PRGF are made in Iran, so though the greater tarrifs for PRP and PRGF injections in medical system in Iran, the total cost of the treatment would be greater in HA group due to the expense of Hyalgan.Based on our results, we recommend the decision makers in Iran that it would be wise to include the PRP under the insurance coverage, till then if a physician wants to choose between PRP, PRGF, Hyalgan, and Ozone in Iran, the first choice could be PRP on the same situation, considering its cost-utility.During last year's, scientists in Iran tried to produce high molecular weight HA internally by cheaper means, so comparing the effectiveness as well as cost-utility of these products with the current available HA in Iranian markets, could be considered as the topic of future studies.