MAINTENANCE – The treatment of osteoarthritis by injection of hyaluronic acid could be reimbursed. For Dr Patrick Sichère, care will become “a luxury”.
The therapeutic arsenal of osteoarthritis is shrinking like grief. The health authorities are said to end the reimbursement of visco-supplementation, a treatment by injection of hyaluronic acid into the joint. A letter of intent to this effect was sent in August to the laboratories that produce these solutions. A big blow for rheumatologists, who treat many patients with these medical devices. For Dr Patrick Sichère, who practices in Paris and at the Saint-Denis Hospital Center (Seine-Saint-Denis), this decision risks causing two-speed medicine.
How do you view this decision?
Patrick Sichere : I am familiar with the case since I participated in the decision to reimburse the treatment several years ago. If it is no longer reimbursed, a whole segment of the population will no longer be able to benefit from it. There is a risk of strengthening two-tier medicine. As a doctor, this shocks me. I can understand that the reimbursement rate is being lowered for financial reasons. But for the treatment to become a luxury seems unacceptable to me.
Today, which patients can benefit from this treatment?
Patrick Sichere : All patients can benefit from it, unless they are on anticoagulants. There must still be some cartilage. The most effective indication remains the knee. Visco-supplementation does a little worse in the hip and ankle.
Is visco-supplementation really effective?
Patrick Sichère: At present, it is the only effective treatment for osteoarthritis. We manage not to see the patient for two years, or even more. Hyaluronic acid exists naturally in the knee, and it goes away with osteoarthritis. Visco-supplementation consists of putting an equivalent back into the joint. We do not yet understand why, but the patients are really relieved. Several recent works provide evidence of a clear improvement. The team that decided on the delisting relied on insufficiently convincing and older work.
Will the delisting really save money?
Patrick Sichère: In France, two times fewer prostheses are fitted than in Germany thanks to visco-supplementation. The patients consume less anti-inflammatory drugs, less analgesics. But it also saves morale, so to speak. When someone has osteoarthritis, they can no longer do physical activity, or even their shopping. It is also a moral attack. With visco-supplementation, we improve comfort and therefore well-being, which can limit the appearance of other disorders, such as depression.
.
