The Cost of PRP: Disparities in orthobiologic utilization

Introduction: This study aims to assess cost and access to orthobiologic injection via platelet rich plasma (PRP). Methods: Retrospective review at one academic affiliated orthopedic practice identified PRP injections for musculoskeletal indications in adult patients between January 1, 2010 and January 1, 2025 via CPT code. Cost of injection per patient category including race, sex, and anatomic location of the injection was analyzed, and US census data utilized to determine correlations between injection utilization and social determinants of health (SDoH) via ZIP code. Comparisons were performed via Wilcoxon rank-sum test or Kruskal–Wallis test. Injection counts aggregated at the ZIP code level were linked to publicly available ZIP-level SDoH variables. Analyses using per-capita injection rates were performed. P < 0.05 was significant. Analyses were performed using R version 4.5.0. Results: Of 727 PRP injections analyzed (57.4 % male, age of 53.0 ± 18.2 years, BMI 28.2 ± 5.5 kg/m²), patient race was predominantly White (87.2 %), followed by Black/African American (8.0 %). The mean charge was $574 ± 362. Males incurred higher charges than females ($598 vs $541; p = 0.001); charges did not differ by race (p = 0.64). Injection utilization demonstrated a strong socioeconomic gradient. The highest-income quartile (mean income ∼$115k) accounted for 40.7 % of injections; the lowest-income quartile (mean ∼$46k) accounted for only 13.6 % (χ²(3) = 114.7, p < 0.001). Education level correlated positively with injection counts; uninsured rate correlated negatively. Injection distribution across income quartiles remained highly unequal after adjusting for population share (χ²(3) = 81.2, p < 0.001). The uninsured rate was the only independent predictor of per-capita injection volume (IRR = 0.90, 95 % CI 0.85–0.95, p < 0.001): each 1 % increase in uninsured residents was associated with a ∼10 % decrease in utilization. Conclusion: PRP injections are disproportionately utilized by older, white, and insured patients from higher-income communities. Given the lack of universal insurance coverage and high out-of-pocket costs, these treatments remain inaccessible for many uninsured and lower-income patients. Level of evidence: Level III; retrospective cohort study.