Cost-benefit analysis of antibiofilm microbiological techniques for peri-prosthetic joint infection diagnosis

Abstract

BackgroundImplant-related infections, including those of peri-prosthetic joint (PJIs), osteosynthesis and other biomaterials, are biofilm-related. Pathogen identification is considered the diagnostic benchmark; however, the presence of bacterial biofilms makes pathogen detection with traditional microbiological techniques only partially effective. To improve microbiological diagnostic accuracy, some biofilm debonding techniques have been recently proposed. Aim of this health economics assessment study was to evaluate their economic impact on hospital costs.MethodsDirect and indirect hospital costs connected with the routine introduction of sonication and dithiothreitol treatment applied to hip and knee PJIs and of tissue cultures were examined. In particular the consequences of diagnostic inaccuracy, the opportunities, costs, and risks of each technique were calculated.ResultsConsidering an average of five samples per patient, processed separately with traditional tissue culture with or without sonication of prosthetic components, or pooled together using the MicroDTTect device (a close system for sample collection, transport and treatment with Dithiothreitol for microbial release from biofilm), the overall mean direct cost per patient was € 397 and € 393 for sonication or MicroDTTect, respectively, compared to € 308 for traditional tissue cultures. In terms of opportunity costs, MicroDTTect was the most effective technique, allowing for a 35% or 55% reduction in time required for sample treatment, compared to tissue cultures combined or not with sonication, respectively.Pooling together direct and indirect costs associated with false positive and negative results of the different diagnostic techniques, unnecessary medical treatments and possible medical claims, MicroDTTect or sonication become increasingly cost-effective when the extra-costs, generated by diagnostic inaccuracy of traditional tissue culture, took place, respectively, in 2% or 20% or more of the patients.ConclusionsThis is the first study specifically focused on the economic impact of the routine clinical use of microbiological antibiofilm sampling and processing techniques in orthopaedics. Although our results may suffer from a potential country and hospital bias, as the data collection process for direct and indirect costs is specific to each institution and country, this analysis highlights the potential economic advantage to hospitals associated with the routine introduction of antibiofilm techniques for microbiological diagnosis of PJI.

Experience With the Use of the MicroDTTect Device for the Diagnosis of Low-Grade Chronic Prosthetic Joint Infections in a Routine Setting

“…Other studies reported good specificity rates, comparable to those of conventional culture, but some of the authors considered that samples were positive only if at least five colonies grew on agar plates after 24 h, whereas this threshold has not been validated by other studies ( 12 , 13 , 15 ). Finally, Romano et al also suggested that the use of the MicroDTTect device may allow a substantial economic balance or advantage ( 20 ). Although the use of MicroDDTect induces an increase of the direct costs compared to culture of PPT samples, the authors showed that this technology was cost-effective notably thanks to the reduction of the time required for sample treatment and the improvement of diagnostic accuracy compared to tissue cultures combined or not with sonication.…”

Sonication Leads to Clinically Relevant Changes in Treatment of Periprosthetic Hip or Knee Joint Infection

“…De Vecchi et al, for example, showed that dithiothreitol treatment for processing periprosthetic tissue showed higher sensitivity and specificity of detection of bacteria compared to routinely used methods (29). Both sonication and duthiothreitol are thought to be cost effective (27). Furthermore, Li et al show promising results of the diagnostic value of sonication fluid in blood culture bottles (30).…”

An update about molecular biology techniques to detect orthopaedic implant-related infections

“…As effectiveness is further improved and knowledge about the clinical meaning increases, these novel techniques will spread and cost-benefit analysis will probably confirm their interest. 20 A better understanding of those that can be clinically applied may offer the clinician more grounds to decide what is to be expected from new diagnostic techniques and eventually decide on their application.…”