The cost effectiveness of vancomycin for preventing infections after shoulder arthroplasty: a break-even analysis
The cost effectiveness of vancomycin for preventing infections after shoulder arthroplasty: a break-even analysis
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DOI：
10.1016/j.jse.2016.07.071
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发表时间：
2017-03-01
影响因子：
3
通讯作者：
Higgins, Laurence D.
中科院分区：
文献类型：
--
作者：
Hatch, M. Daniel;Daniels, Stephen D.;Higgins, Laurence D.
Background: Increasing methicillin resistance and recognition of Propionibacterium acnes as a cause of infection in shoulder arthroplasty has led to the adoption of local vancomycin powder application as a more effective method to prevent expensive periprosthetic infections. However, no study has analyzed the cost effectiveness of vancomycin powder for preventing infection after shoulder replacement.Methods: Cost data for infection-related care of 16 patients treated for deep periprosthetic shoulder infection was collected from our institution for the break-even analysis. An equation was developed and applied to the data to determine how effective vancomycin powder would need to be at reducing a baseline infection rate to make prophylactic use cost effective.Results: The efficacy of vancomycin (absolute risk reduction [ARR]) was evaluated at different unit costs, baseline infection rates, and average costs of treating infection. We determined vancomycin to be cost effective if the initial infection rate decreased by 0.04% (ARR). Using the current costs of vancomycin reported in the literature (range: $2.50/1000 mg to $44/1000 mg), we determined vancomycin to be cost effective with an ARR range of 0.01% at a cost of $2.50/1000 mg to 0.19% at $44/1000 mg. Baseline infection rate does not influence the ARR obtained at any specific cost of vancomycin or the cost of treating infection.Conclusions: We have derived and used a break-even equation to assess efficacy of prophylactic antibiotics during shoulder surgery. We further demonstrated the prophylactic administration of local vancomycin powder during shoulder arthroplasty to be a highly cost-effective practice. (C) 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.
