Cost-Effectiveness of Antibiotic-Impregnated Bone Cement Used in Primary Total Hip Arthroplasty

Cummins, Justin S.; Tomek, Ivan M.; Kantor, Stephen; Furnes, Ove; Engesæter, Lars B.; Finlayson, Samuel R.G.

doi:10.2106/jbjs.g.01029

Cited by 79 publications

(63 citation statements)

References 17 publications

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“…The structural quality of all four economic evaluations was high, although Cummins et al 54 failed to clearly state the perspective of the evaluation and Elliott et al 55 did not clearly define the time horizon. Dimensions of data quality were fulfilled by most studies, but two, by Cummins et al 54 and Elliott et al, 55 failed to provide sources of data for at least one parameter.…”

Section: Quality Assessmentmentioning

confidence: 95%

“…[53][54][55][56][57] However, two studies were conducted by the same author group: one was a cost-effectiveness evaluation and the second was a systematic review with a cost-effectiveness evaluation. 53 As the same decision problem and decision model were used in both these publications, only the more recent and updated article was included.…”

Section: Description Of Cost-effectiveness Evidencementioning

confidence: 99%

“…55 The characteristics of the remaining four studies are summarised in Table 4. Cummins et al 54 evaluated the cost-effectiveness of using antibiotic-impregnated bone cement in primary THA compared with standard bone cement. They used the rate of revisions and, in particular, revisions resulting from infection as primary outcome measures in their Markov model.…”

Section: Description Of Cost-effectiveness Evidencementioning

confidence: 99%

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A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

Graves

Wloch

Wilson

et al. 2016

Health Technol Assess

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BackgroundA deep infection of the surgical site is reported in 0.7% of all cases of total hip arthroplasty (THA). This often leads to revision surgery that is invasive, painful and costly. A range of strategies is employed in NHS hospitals to reduce risk, yet no economic analysis has been undertaken to compare the value for money of competing prevention strategies.ObjectivesTo compare the costs and health benefits of strategies that reduce the risk of deep infection following THA in NHS hospitals. To make recommendations to decision-makers about the cost-effectiveness of the alternatives.DesignThe study comprised a systematic review and cost-effectiveness decision analysis.Setting77,321 patients who had a primary hip arthroplasty in NHS hospitals in 2012.InterventionsNine different treatment strategies including antibiotic prophylaxis, antibiotic-impregnated cement and ventilation systems used in the operating theatre.Main outcome measuresChange in the number of deep infections, change in the total costs and change in the total health benefits in quality-adjusted life-years (QALYs).Data sourcesLiterature searches using MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials were undertaken to cover the period 1966–2012 to identify infection prevention strategies. Relevant journals, conference proceedings and bibliographies of retrieved papers were hand-searched. Orthopaedic surgeons and infection prevention experts were also consulted.Review methodsEnglish-language papers only. The selection of evidence was by two independent reviewers. Studies were included if they were interventions that reported THA-related deep surgical site infection (SSI) as an outcome. Mixed-treatment comparisons were made to produce estimates of the relative effects of competing infection control strategies.ResultsTwelve studies, six randomised controlled trials and six observational studies, involving 123,788 total hip replacements (THRs) and nine infection control strategies, were identified. The quality of the evidence was judged against four categories developed by the National Institute for Health and Care ExcellenceMethods for Development of NICE Public Health Guidance(http://publications.nice.org.uk/methods-for-the-development-of-nice-public-health-guidance-third-edition-pmg4), accessed March 2012. All evidence was found to fit the two highest categories of 1 and 2. Nine competing infection control interventions [treatments (Ts) 1–9] were used in a cohort simulation model of 77,321 patients who had a primary THR in 2012. Predictions were made for cases of deep infection and total costs, and QALY outcomes. Compared with a baseline of T1 (no systemic antibiotics, plain cement and conventional ventilation) all other treatment strategies reduced risk. T6 was the most effective (systemic antibiotics, antibiotic-impregnated cement and conventional ventilation) and prevented a further 1481 cases of deep infection, and led to the largest annual cost savings and the greatest gains to QALYs. The additional uses of laminar airflow and body exhaust suits indicate higher costs and worse health outcomes.ConclusionsT6 is an optimal strategy for reducing the risk of SSI following THA. The other strategies that are commonly used among NHS hospitals lead to higher cost and worse QALY outcomes. Policy-makers, therefore, have an opportunity to save resources and improve health outcomes. The effects of laminar air flow and body exhaust suits might be further studied if policy-makers are to consider disinvesting in these technologies.LimitationsA wide range of evidence sources was synthesised and there is large uncertainty in the conclusions.FundingThe National Institute for Health Research Health Technology Assessment programme and the Queensland Health Quality Improvement and Enhancement Programme (grant number 2008001769).

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Section: Quality Assessmentmentioning

confidence: 95%

Section: Description Of Cost-effectiveness Evidencementioning

confidence: 99%

Section: Description Of Cost-effectiveness Evidencementioning

confidence: 99%

See 1 more Smart Citation

A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

Graves

Wloch

Wilson

et al. 2016

Health Technol Assess

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“…We used a point estimate of halfway between these two values and sensitivity analysis to further explore its effect. Reoperations were associated with a disutility owing to the temporarily undesirable postsurgical state [9,17]. A disutility was estimated for readmission, although it was 1 .…”

Section: Methodsmentioning

confidence: 99%

Short-term Complications Have More Effect on Cost-effectiveness of THA than Implant Longevity

Shearer

Youm

Bozic

2015

Clinical Orthopaedics &Amp; Related Research

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Background Outcomes research in THA has focused largely on long-term implant survivorship as a primary outcome and emphasized the development of new implant technologies. In contrast, strategies to improve short-term outcomes, such as the frequencies of periprosthetic joint infections and unplanned readmissions, have received less attention. Questions/purposes We asked whether reductions in periprosthetic joint infections and early readmissions would have greater influence on the net monetary benefit (a summation of lifetime cost and quality of life) for THA compared with equivalent reductions in aseptic loosening. Methods A Markov model was created using decisionanalysis software with six health states and death to represent seven major potential outcomes of THA. We compared the effect of a 10% reduction in each of the following outcomes: (1) periprosthetic joint infection, (2) hospital readmission, and (3) aseptic loosening. Procedure costs (not charges) were derived from our hospital costaccounting system. Probabilities were derived primarily from the Australian Orthopaedic Association National Joint Replacement Registry, and utilities were estimated from a previous study at our institution using the time trade-off method. The primary outcome of the study is the net monetary benefit, which combines the reductions in cost and improvement in health-related quality of life in a single metric. Quality of life is expressed in quality-adjusted life years (QALYs), which are calculated by multiplying the utility of a health state (ranging from 0 to 1) by the duration of time in the health state. The cost and QALYs are reported separately as secondary outcomes. One-way and multivariate sensitivity analyses were performed including a probabilistic sensitivity analysis to account for uncertainty in model inputs. Results The net monetary benefit for a 10% reduction in periprosthetic joint infections was USD 278 (95% CI, USD 239-295) per index procedure compared with USD 174 (95% CI, USD 150-185) and USD 113 (95% CI, USD 94-129) for reductions in aseptic loosening and early readmission, respectively. Compared with the base case, reductions in cost associated with a 10% reduction in periprosthetic joint infections, early readmissions, and aseptic loosening were USD 98, USD 93, and USD 75 per index procedure, respectively. The increase in QALYs for One of the authors (KJB) certifies that he has received or may receive payments or benefits, during the study period, an amount less than USD 10,000 from Institute for Healthcare Improvement (Cambridge, MA, USA), less than USD 10,000 from Harvard Business School (Cambridge, MA, USA), and USD 10,000-USD 100,000 from Pacific Business Group on Health (San Francisco, CA, USA). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Each author certifies that the institution where the work was performed approved the human protocol for this investigat...

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“…A prior study applied a disutility of 0.1 to primary THA, 0.12 to revision THA, and 0.2 for revision as a result of infection with the assumption that a disutility of 0.1 is equivalent to 5 weeks of poor health [12]. For our model we applied the aforementioned disutilities to THA as well as a disutility of 0.05 to hip arthroscopy.…”

Section: Methodsmentioning

confidence: 99%

Is Hip Arthroscopy Cost-effective for Femoroacetabular Impingement?

Shearer

Kramer

Bozic

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background The impact of hip arthroscopy on healthrelated quality of life (HRQoL) among younger patients with symptomatic femoroacetabular impingement (FAI) is unknown, but with increasing recognition of the condition there is likely to be increasing demand for arthroscopy. Questions/purposes We describe an approach to determine the incremental cost-effectiveness of hip arthroscopy compared with observation in patients with FAI; we also identified variables that influence its cost-effectiveness. Patients and MethodsWe constructed a Markov model including possible health states for 36-year-old patients with FAI using decision analysis software and compared two strategies: (1) observation and (2) hip arthroscopy, followed by THA with disease progression. We estimated the ratio of the incremental cost to the incremental benefit (reflected by HRQoL) of both strategies. We identified studies reporting Harris hip scores and complications after arthroscopy to estimate health state preferences and their probabilities. We performed sensitivity analyses on 30 input variables over a plausible range of estimates to determine

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Cost-Effectiveness of Antibiotic-Impregnated Bone Cement Used in Primary Total Hip Arthroplasty

Cited by 79 publications

References 17 publications

A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

A cost-effectiveness modelling study of strategies to reduce risk of infection following primary hip replacement based on a systematic review

Short-term Complications Have More Effect on Cost-effectiveness of THA than Implant Longevity

Is Hip Arthroscopy Cost-effective for Femoroacetabular Impingement?

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