The use of orthobiologics is a hot trend in orthopaedics, but new research from the University of Alabama at Birmingham (UAB) shows great variability in the cost for these therapies. The UAB study, published in Sports Health, examined 2 orthobiologics – platelet-rich plasma injections and stem cell injections – and found costs ranging from a few hundred dollars to as much as $12,000 per treatment.
This is troublesome, the UAB researchers said, especially for therapies that are yet to be conclusively proven effective.
“Research into the efficacy of these therapies is mixed at best,” said Amit Momaya, MD, assistant professor in the Department of Orthopaedic Surgery at the UAB School of Medicine and the study’s first author. “Some studies show benefit, others do not. 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 such as platelet-rich plasma injections and stem cell injections have been suggested to improve healing and manage pain following orthopaedic injury. Because they are autologous therapies, 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, MD, professor of orthopaedics 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.”
Regional Differences in Cost
The UAB researchers surveyed 1345 orthopaedic sports medicine practices around the US to determine 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. Geographically, costs were higher in the western regions of the country and lower in the south. 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 $4973. Stem cell injections had a mean cost of $2728, ranging from $300 to $12,000. In most cases, insurance does not cover the cost of these injections.
“The differences in cost are significant and you could certainly ask if these differences are unethical,” Dr. Momaya said. “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. Do they have accurate expectations? Just because a desperate patient has the means to pay thousands of dollars, is it right for medical professionals to charge that much?”
Investigating the Potential Benefits
Physicians in UAB’s Department of Orthopaedics offers platelet-rich plasma injections and stem cell injections for some conditions, charging at the low end of the cost range. Those who offer orthobiologics are following their patients over time to learn more about the effectiveness of these therapies.
“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,” Dr. Ponce said. “As that process continues, consumers need to be better educated. We fear there is misleading information circulating about orthobiologics, which helps create an environment with widely fluctuating costs.”
Dr. Ponce and Dr. Momaya suggest that patients interested in orthobiologics should shop around to find appropriate medical professionals who will follow and track their outcomes or consider enrolling in a clinical trial.
“We are not against the use of orthobiologics,” Dr. Momaya said. “We use them ourselves as we work to understand which conditions and which patients are most likely to benefit from these therapies.
“But until we can say with confidence that these are effective, we have to urge patients to use caution and get as much information as possible about effectiveness and cost before pursuing orthobiologic therapy.”
AAOS Investment in Orthobiologics Knowledge
The American Academy of Orthopaedic Surgeons (AAOS) is also concerned about information on orthobiologics. The organization announced in November 2019 that it will make a strategic investment in creating evidence-based, unbiased information, thought-leadership, position statements, and educational content over the next 5 years to help shape and guide orthopaedic surgeons and their patients within this space.
The goal is to identify and build on the gaps within the orthobiologics field for musculoskeletal care treatment options, as well as address concerns stemming from misinformation of direct-to-consumer advertising of orthobiologic treatments to patients.
“The AAOS is poised to play a critical role in steering orthopaedic biologics discovery and content for surgeons and patients around the world,” said Philipp Leucht, MD, FAAOS, member of the AAOS Committee on Biologics and Regenerative Medicine. “It’s one more step towards helping the musculoskeletal community separate fact from fiction, ultimately helping patients achieve the highest quality of care.”
Momaya AM, McGee AS, Dombrowsky AR, Wild AJ, Faroqui NM, Waldrop RP, He JK, Brabston EW, Ponce BA. The cost variability of orthobiologics. Sports Health. 2020 Jan/Feb;12(1):94-98. doi: 10.1177/1941738119880256. Epub 2019 Oct 30.