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Euflexxa Injections vs Synvisc - Which One Is Best?

Hyaluronic derivatives, called antirheumatics, are used for osteoarthritis and other conditions of joints in which the body’s natural version of lubricant no longer functions as an adequate shock absorber, most notably, in the arthritic knee. These pharmaceuticals are used when other measures fail. They are viscous substances that are injected into an osteoarthritic joint—specifically, the knee, and this “viscosupplementation” helps to lubricate the joint, thereby diminishing friction, inflammation, and resulting pain. The real benefit is to delay—or even prevent—total knee replacement. And it may not be just one knee, as artificial knees have a life span, so a young person is probably fated to have a second replacement.

Hyaluronic derivatives

Sodium hyaluronate is a biological polysaccharide commonly involved with connective tissue, especially important in synovial fluid. The hyaluronic derivatives form a viscous, elastic solution that serves as a tissue or joint lubricant when introduced via injection. Most of the hyaluronic derivatives come from rooster combs. One hyaluronic derivative in particular—Euflexxa—is different in that it is produced commercially from bacterial cells; thus, Euflexxa is the first non-avian-derived hyaluronic derivative.1

QALY and the cost of a year’s worth of quality life

Typically, the choice of which drug to prescribe is based on risk-vs-benefit. Cost-effectiveness comes into play, too, when third-party payers implement cost-containment measures. The one-time dosing of Synvisc-One is misleading, since it turns out that the one dose is about three times the cost of its thrice-given weekly dosing; therefore, any savings will be realized only by fewer co-pays of fewer office visits.

The scientific literature on these injections, however, incorporate a very important factor on the costs—the delay in total knee replacement that can be achieved. The longer the delay, the more the cost savings.

There is a rubric used to determine the QALY (cost-utility per quality-adjusted life-years), a fancy way to describe the cost-effective ratio toward an improved quality of life. Of the hyaluronic derivatives, all had similar QALY scores, except for one called Euflexxa, which had the best score.2

Euflexxa and Synvisc

  1. Synvisc (hylan G-F 20) is a brand name for the high molecular weight injectable fluid that contains both hylan A and hylan B polymers derived from rooster combs. Like most hyaluronic derivatives, it is termed an avian-derived hyaluronic acid (AV-HA).3
  2. Euflexxa, on the other hand, is derived from a careful, multi-step process. A very highly purified product extracted from bacterial cells, it is a polysaccharide consisting of a repeating disaccharide of N-acetylglucosamine and sodium glucuronate, linked by glycosidic bonds.4

The difference between Euflexxa and Synvisc

While Supartz, Synvisc, and other AD-HA brands are similar in their efficacy, Synvisc offers a one-dose regimen that saves multiple trips to a doctor’s office. According to the National Institute of Health in the USA, they all appear to relieve pain from 4-14 weeks by restoring both mechanical and biomechanical homeostasis in the joint.5

A difference in price gives Euflexxa a bit of an edge—about 20%, but in a free-market economy, the balance between it and the AV-HAs is likely to flip repeatedly. On the other hand, a total knee replacement can be over $20,000 (USD). Nevertheless, at the present time, Euflexxa’s top QALY score and present favorable costs make it noteworthy in recommending it.


  6. Rosen J, Sancheti P, Fierlinger A, Niazi F, Johal H, Bedi A. Cost-Effectiveness of Different Forms of Intra-Articular Injections for the Treatment of Osteoarthritis of the Knee. Advances in Therapy. 2016;33:998-1011. doi:10.1007/s12325-016-0331-8.

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