dc2md

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has anyone come across any studying comparing hyalgan and synvisc? i've done google and pubmed (etc.) searches and haven't found anything. my initial guess is that synvisc is more effective...but then again i have no studies to support this.
and what about the cost between the two...haven't spoken to either vendor yet.
thanks,
chris
 

axm397

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has anyone come across any studying comparing hyalgan and synvisc? i've done google and pubmed (etc.) searches and haven't found anything. my initial guess is that synvisc is more effective...but then again i have no studies to support this.
and what about the cost between the two...haven't spoken to either vendor yet.
thanks,
chris
I went to a peripheral injection course where they quoted info from the "product information" available from their respective companies. Synvisc (hyalan G-F 20) requires 3 injections and provides 6 months of relief. Hyalgan provides 60days of relief with 3 injections and 6 months of relief with 5 injections.

Synvisc's molecular weight is 6 million daltons with 111Pa at 2.5Hz elasticity and viscoity of 25Pa at 2.5Hz compared to Hyalgan which is 0.5-0.7 million daltons, 0.6Pa at 2.5Hz elasticity, and 3Pa at 2.5Hz viscosity. Healthy young people's synovial fluid's hyaluronic acid has molecular weight of 6 million daltons, elasticity of 117Pa at 2.5H and viscosity of 45Pa at 2.5Hz. (Belaze EA, Walson D, Duff IF, et al. Hyaluronic acid in synovial fluid.... Arthritis Rheum 1967;10:357-376.) So Synvisc is more similar to "normal" people's hyaluronic acid.

There is no head to head study that I know of. The instructor felt that because synvisc requires less number of injections, has closer molecular profile to hyaluronic acid found is "normal" people, that synvisc is superior to hyalgan and therefore almost exclusively uses synvisc.

I do have to say that I believe the workshop was partly sponsored by synvisc - so definitely could be biased.
 

dc2md

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thanks axm. so even if 5 injections of hyalgan cost the pt the same as 3 injections of synvisc, that's 2 extra visits the pt would have to deal with. now of course the money hungry docs will look at that as being 2 extra injection fees they can charge the insurance companies. unless a head-to-head shows a clear winner, i'll stick with synvisc.
 
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Finally M3

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One of the companies (forgot which, I think it was Synvysc) was coming out with a one-shot treatment formulation.

We only use Synvisc for some reason.
 

SOUNDMAN

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Synvisc does have the possibility of developing the "hot knee" acute synovial inflammation. I've only seen it once, but needless to say it's been reported in the literature, where as I believe Hyalgan does not report this AE.

I believe cost is nearly the same between the 3 and 5 injections, atleast it was in our office and we used both. Both seemed to work similarly, neither stood out above the rest.
 

ampaphb

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Synvisc does have the possibility of developing the "hot knee" acute synovial inflammation. I've only seen it once, but needless to say it's been reported in the literature, where as I believe Hyalgan does not report this AE.

I believe cost is nearly the same between the 3 and 5 injections, at least it was in our office and we used both. Both seemed to work similarly, neither stood out above the rest.
We had better success with Orthovisc and Euflexa than either of the other two mentioned on this thread.

Theoretically, both offer molecular weights that better approximate joint fluid, and both are "more pure" than the others, for what that's worth.

Synvisc is far more expensive than the others, but with average wholesale price now dictating reimbursement, it does not appear to matter whose is cheaper, as each is reimbursed under its own j-code
 
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oreosandsake

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I took my grandmother to this orthopedist 2 years ago and he injected her knees with synvisc.

my mom went today ( I couldn't go w/ her since i have rotations) and he wrote her a prescription to go purchase 5 vials of hyalgan and said, "bring these back and I'll inject them for you"

(I think since we are paying cash only, and we have family in healthcare... he is assuming we can source it at a favorable rate??)

anyhow... if this was your family member, which of these two products would you recommend?

btw, He said that the hyalgan should cost about $120 per x 5.
 

PMR 4 MSK

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I took my grandmother to this orthopedist 2 years ago and he injected her knees with synvisc.

my mom went today ( I couldn't go w/ her since i have rotations) and he wrote her a prescription to go purchase 5 vials of hyalgan and said, "bring these back and I'll inject them for you"

(I think since we are paying cash only, and we have family in healthcare... he is assuming we can source it at a favorable rate??)

anyhow... if this was your family member, which of these two products would you recommend?

btw, He said that the hyalgan should cost about $120 per x 5.
I used to use a lot of Hyalgan, now more Synvisc. IME Synvisc helps 3 - 6 months, Hyalgan 6 months +, but it's harder to get someone to agree to 5 injections than 3. Each one helps about 2/3rds of the patient's I inject.
 

Ludicolo

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We’ve been using Euflexxa over Synvisc recently. The hospital here used Hyalgan in the past but stopped before I joined. Cost (for the entire set of injections) is fairly similar across the board. Efficacy and duration seems to be about the same for all, depending on the severity of OA. I’ve seen the “hot knee” reaction twice with the Synvisc, haven’t yet with the Euflexxa. Personally, I would prefer getting 3 injections instead of 5.

Any word on the single-shot viscosupplementation?
 

PMR 4 MSK

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curious if there are any new "updates" on this topic.

injected my first knee yesterday :D
Only new thing is Synvisc One - 1 shot instead of 3. I haven't tried it yet.
 

lobelsteve

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Only new thing is Synvisc One - 1 shot instead of 3. I haven't tried it yet.
Synvisc One dinner lecture last year provided data showing Synvisc one was "almost" as effective as Synvisc.

Anyone getting 5 shots is crazy when 3 works as well. I think it has to do with the 20610 and not the effectiveness of the product.

If Synvisc One works as well but only lasts 4 months- I'd use this 3x per year and be done with it.

There are also generic/compounded Synviscs out there- same J-code but less cost. Unknown purity/quality control- only drawbacks.
 

oreosandsake

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curious, is the reimbursement (medicare) for doing a synvisc injection paid each time you perform the injection, or for the entire series in one lump fee?
 

RUOkie

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curious, is the reimbursement (medicare) for doing a synvisc injection paid each time you perform the injection, or for the entire series in one lump fee?
You bill a 20610 (large joint injection) for each time you stick a needle in the knee. But the J-code for the medication (assuming you purchase the med yourself and then bill Medicare B for it) is different for each formulation-thus, you get proportionally less for the 5X injection than for the 3X injection and so forth.
 

oreosandsake

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You bill a 20610 (large joint injection) for each time you stick a needle in the knee. But the J-code for the medication (assuming you purchase the med yourself and then bill Medicare B for it) is different for each formulation-thus, you get proportionally less for the 5X injection than for the 3X injection and so forth.

thank you :)
 

oreosandsake

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would you inject someones knee if the xray did not show arthritis but they had knee pain?
XR is a very crude device to evaluate for OA. poor sensitivity for early disease.

in early joint disease, XR will not have any stigmata but MRI or US will.
 
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