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Hospitals preferred decolonization for treatment of periprosthetic joint infection
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DALLAS — Although nasal-only Staphylococcus aureus screening may be considered the most cost-effective treatment option for periprosthetic joint infection from the patient and societal perspective, universal decolonization was deemed as more cost-effective from the hospital perspective, according to study results presented here.
“When we prevent periprosthetic joint infections [PJIs], we are talking about choosing the right patients, employing the right preoperative measures and using the right intraoperative and postoperative care,” Andy O. Miller, MD, said at the American Association of Hip and Knee Surgeons Annual Meeting. “Today, we are talking about preoperative measures to reduce infection, specifically decolonization of Staphylococcus aureus carriage.”
Miller and his colleagues compared the sensitivity and costs of three S. aureus protocols (nasal swab; nasal swab and one other swab; and nares, axillae, groin and pharynx swabs) with no-testing, no-treatment and universal decolonization strategies. A total of 1,418 patients at an orthopedic hospital between 2008 and 2015 were evaluated.
Researchers identified cost-effectiveness by evaluating hospital, patient and societal perspectives: what the hospital pays for screening and infection; what the patient pays for mupirocin and chlorhexidine; and the combined hospital and patient perspective.
From the patient and societal perspective, the nasal-swab strategy was the most cost-effective treatment option, with an incremental cost of $13,000 per prevented PJI. From the hospital perspective, decolonization was deemed as the most dominant treatment option, although the nasal-swab strategy remained cost-effective, with an incremental cost of $9,000 per prevented PJI, Miller said.
More nasal swabs identified more S. aureus, but additional nasal swabs lowered its cost-effectiveness.
“Different strategies differ in cost-effectiveness. In our model, universal decolonization is broadly cost-effective and could be highly cost-effective in hospitals and among patient subgroups with average or high PJI rates,” he said. – by Nhu Te
Reference:
Miller AO, et al. Paper #18. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 10-13, 2016; Dallas.
Disclosure: Miller reports no relevant financial disclosures.