Vancomycin Powder Is Highly Cost-Effective in Total Ankle Arthroplasty

Abstract

Prosthetic joint infection (PJI) is a costly and potentially fatal complication in total ankle arthroplasty (TAA). Some surgeons apply topical vancomycin powder to minimize the risk of infection during TAA procedures. The purpose of our study was to determine the cost-effectiveness of using vancomycin powder to prevent PJI following TAA and to propose an economic model that can be applied by foot and ankle surgeons in their decision to incorporate vancomycin powder in practice. Using our institution’s records of the cost of 1 g of topical vancomycin powder, we performed a break-even analysis and calculated the absolute risk reduction and number needed to treat for varying costs of vancomycin powder, PJI infection rates, and costs of TAA revision. Costing $3.06 per gram at our institution, vancomycin powder was determined to be cost-effective in TAA if the PJI rate of 3% decreased by an absolute risk reduction of 0.02% (Number Needed to Treat = 5304). Furthermore, our results indicate that vancomycin powder can be highly cost-effective across a wide range of costs, PJI infection rates, and varying costs of TAA revision. The use of vancomycin powder remained cost-effective even when (1) the price of vancomycin powder was as low as $2.50 to as high as $100.00, (2) infection rates ranged from .05 to 3%, and (3) the cost of the TAA revision procedure ranged from $1000 to $10 000. Levels of Evidence: IV

The Cost-Effectiveness of Smoking Cessation Programs for Prevention of Wound Complications Following Total Ankle Arthroplasty: A Break-Even Analysis

“…This methodology has been previously used in orthopaedic studies to economically justify the utility of a preoperative intervention to prevent postoperative infection. 6 , 14 , 21 - 23 The equation in Figure 1 was used to calculate the break-even wound complication rate ( IR f ) following utilization of a smoking cessation program using the initial wound complication rate in those who did not use a smoking cessation program ( IR i ), the cost of I&D surgery ( C i ), and the cost of a smoking cessation program ( C s ). The ARR was calculated as the difference between IR i and IR f .…”

Use of topical vancomycin powder in total joint arthroplasty: Why the current literature is inconsistent?

“…Similarly, studies on the application of topical VP in foot and ankle surgery and in total ankle arthroplasty (TAA) are limited, however, the economic viability has been investigated by Nam et al [ 22 ]. At their institutional cost of UD$3.06 per gram and a TAA PJI rate of 3%, VP would be cost-effective for TAA revision costs with an absolute risk reduction of 0.02% (number needed to treat = 5304).…”