The use of orthobiologics is a hot trend in orthopaedics, but new research from the University of Alabama at Birmingham suggests consumers should do their homework.
A UAB study, published in Sports Health in October 2019 and conducted by Amit Momaya, M.D., assistant professor in the Department of Orthopaedic Surgery at the UAB School of Medicine, and others, looked at two orthobiologic therapies — platelet-rich plasma injections and stem cell injections — and found a dramatic cost variability ranging from a few hundred dollars to thousands. Momaya and the other researchers say this cost fluctuation is troublesome, especially for therapies that are yet to be conclusively proven effective.
“Research into the efficacy of these therapies is mixed at best,” said Momaya. “Some studies show benefit, others don’t. More research is needed to definitively determine their effectiveness, but in the meantime, consumers can find themselves paying a lot of money for something that may — or may not — work.”
Orthobiologics have been suggested to improve healing and manage pain following orthopaedic injury. They are autologous therapies, which are derived from the patient’s own blood or cells. However, because they are autologous, their use is not highly regulated by the government and there is minimal oversight from the public health community.
“Platelet-rich plasma injections are FDA approved for bone grafts, but not for other uses for which they are now marketed,” said Brent Ponce, M.D., professor of orthopaedics at UAB and senior author of the paper. “As physicians, we think there is cause for concern when an experimental therapy can cost hundreds of dollars at one health care provider and thousands at another. There is a tremendous need for consumer education and for more regulatory oversight.”
Momaya and Ponce’s team surveyed 1,345 orthopaedic sports medicine practices around the U.S., asking if orthobiologics were offered and at what cost. Roughly two thirds of the responding practices offered one or both of the therapies. In general, costs were higher in affluent areas of larger cities and geographically they were higher in the western regions of the country. Large orthopaedic practices were more likely to have higher prices than smaller practices.
The mean cost of the platelet-rich plasma injection was $707, with a range of $175 to $4,973. Stem cell injections had a mean cost of $2,728, ranging from $300 to $12,000.
“We understand that there are patients willing to pay for a therapy they hope will stave off major surgery such as joint replacement, but we are concerned whether patients are getting the facts about what these therapies can and cannot do,” Momaya said.
UAB’s Department of Orthopaedics offers platelet-rich plasma injections and stem cell injections for some conditions, and the hospital fell at the low end of the cost range for these therapies. However, UAB physicians who offer orthobiologics are also following their patients’ progress over time to learn more about the effectiveness of the treatments.
“There is reason to think that orthobiologics might be beneficial, and it is incumbent on the medical profession to study their effectiveness and determine how best to utilize these therapies,” Ponce said.
Ponce and Momaya suggest that patients interested in orthobiologics should shop around. They recommend using a directory of sports medicine surgeons from the American Orthopaedic Society for Sports Medicine to fine appropriate medical professionals. They also suggest enrolling in a clinical trial or at least working with a medical team that seeks to track outcomes from the use of the therapies.
Momaya and Ponce were joined on the study by co-authors Eugene Brabston, M.D.; Andrew McGee, Alexander Dornbrowsky, Raymond Waldrop and Jun Kit He from UAB; Alan Wild of the Alabama College of Osteopathic Medicine and Naqeeb Faroqui of Mercer University School of Medicine.