Summary

This is a prospective study investigating geographic variation in availability and pricing of platelet-rich plasma injections for knee osteoarthritis.

Abstract

Background

Demand for costly cash-pay platelet-rich plasma (PRP) injections for knee osteoarthritis (OA) has dramatically increased in recent years despite a lack of consensus on its efficacy. This off-label use is not covered by insurance and patients often pay =$700 per PRP injection, generally administered in a series of 3. Given increasing demand for PRP, hypothesized price variation and the significant financial burden on patients, we aim to: 1) report the availability and pricing of PRP at top-ranked orthopedic institutions, 2) characterize the availability of pricing information over the phone, and 3) determine which hospital characteristics are associated with PRP pricing.

Methods

In this prospective study (Institutional Review Board approval 21-01820), telephone calls were used to obtain price estimates from a sample of 100 hospitals (top 25 from each U.S. Census region) selected from the U.S. News & World Report ranking of Best Hospitals for Orthopedics. A standardized script was used to determine the availability and price of a PRP injection for knee OA. Hospital characteristics were extracted from American Hospital Association data. Analyses were stratified by region. Spearman’s rank correlations assessed the association between (continuous) hospital characteristics and PRP pricing. Analyses were performed using SAS statistical software, version 9.4.

Results

Overall, 87% of respondents at top-ranked orthopedic institutions stated that they offered PRP injections; of these, 68% (59/87) were willing to disclose PRP pricing information over the phone. PRP pricing ranged from $350.00 to $2,815.00 (median $800) per injection with the highest prices observed in the Northeast. The largest pricing range was observed in the Midwest while over two thirds of hospitals that disclosed pricing were in the $500-$1,000 price range. No significant correlations were observed between PRP price and continuous hospital characteristics.

Discussion

Our results demonstrate there is substantial PRP price variability between providers, and pricing is not correlated with various continuous hospital characteristics. These data provide important insights given the increasing research and clinical interest in the use of PRP for knee OA and its cost-effectiveness. Indeed, recent cost-effectiveness research comparing PRP injections to hyaluronic acid or immediate total knee arthroplasty show that the high cost of PRP continues to be an issue relative to its purported effectiveness. While a 2017-2018 study of providers advertising PRP injections online identified significant variation in claims of effectiveness, incremental evidence has come supporting the efficacy of PRP, and an increasing number of providers are offering PRP. By improving transparency in PRP pricing within the mainstream orthopedic community, this investigation provides a useful resource for pricing comparisons and future investigations of the financial burden and cost-effectiveness of PRP injections.
Study limitations include those related to generalizability; not all hospitals wished to disclose their prices, and PRP for other indications may have different price variations. Moreover, we cannot rule out that hospitals with higher prices could have been more likely to withhold pricing disclosure. In conclusion, our study provides important insights into geographic differences in pricing for PRP injections for knee OA.