OBJECTIVES: Osteoarthritis (OA) is the most common and costly bone and joint disease in the elderly. Recently, viscosupplementation, an intra-articular injection of artificial joint fluid in order to restore rheological properties affecting lubrication and shock absorption, has introduced as an alternative conservative treatment. To assess the effectiveness and cost-effectiveness of Hylan G-F 20 (Hylan) as a substitute for existing treatments for pain due to OA of the knee, other viscosupplementation devices, and/or as an adjunct to conventional therapy. METHODS: A Markov microsimulation model was developed to define a treatment pathway for OA of the knee, illustrate the current costs of treating patients with the condition, and demonstrate the potential savings associated with introduction of Hylan. A hypothetical cohort of patients categorized as having 2-3 or 4 degree of OA of the knee was followed over a 30-month time period. RESULTS: When comparing intra-articular administration of Hylan, the use of NSAIDs and intra-articular administration of corticosteroids (GCS), rirost costs compared with the strategy of NSAIDs amounted to $192 rate per 1 patient. This increase in efficiency of 20% in favor of Hylan. Accordingly, the ratio ICER was $979 per patient, which is much below the threshold of "society's willingness to pay." Markov cycle for patients with OA of the knee of 4 degrees showed that use of Hylan is more effective in the end point of modeling the effectiveness of this strategy was 12% (compared to 0% in the policies of NSAIDs and corticosteroids). We calculated the total cost of the budget in the application of NSAIDs, GCS, and Hylan, after calculations found that the use of Gilan can save significant budget funds - up to $954582 (for 1,000 patients). CONCLUSIONS: Hylan may delay the need for joint replacement in patients with OA of 4 degrees, suggest its use is justified from a clinical and economic standpoint as compared to the consideration of other treatment strategies.