Next-Generation Sequencing vs Culture-Based Methods for Diagnosing Periprosthetic Joint Infection After Total Knee Arthroplasty: A Cost-Effectiveness Analysis
Next-Generation Sequencing vs Culture-Based Methods for Diagnosing Periprosthetic Joint Infection After Total Knee Arthroplasty: A Cost-Effectiveness Analysis
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DOI：
10.1016/j.arth.2019.03.029
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发表时间：
2019-07-01
影响因子：
3.5
通讯作者：
Moschetti, Wayne E.
中科院分区：
文献类型：
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作者：
Torchia, Michael T.;Austin, Daniel C.;Moschetti, Wayne E.
背景：全膝关节置换术后假体周围关节感染（PJI）的诊断具有挑战性。与基于培养的技术相比，下一代测序（NGS）在识别生物体方面更敏感，但特异性也更低且更昂贵。到目前为止，还没有研究比较这两种方法诊断PJI后全膝关节arthroplasty.Methods的成本效益：马尔可夫，状态转换模型预测寿命成本和质量调整寿命年（QHLS），从社会的角度来确定成本效益。主要结果是增量成本效益比，支付意愿阈值为10万美元/QALY。进行敏感性分析，以评估参数assumptions.Results：在我们的基本情况下的值，文化没有被确定为具有成本效益相比，NGS，与增量成本效益比为422,784美元每QALY。单向敏感性分析发现，NGS是PJI的成本效益选择，其预测概率为45.5%。此外，如果NGS的敏感性大于70.0%，特异性大于94.1%，则NGS具有成本效益。双向敏感性分析表明，预测试概率和测试性能参数（灵敏度和特异性）是最大的因素，用于确定是否一个特定的策略是cost-effective.Conclusion：我们的模型的结果表明，NGS诊断PJI的成本效益主要取决于PJI的预测试概率和NGS技术的性能特点。我们的研究结果是一致的想法，NGS应保留的临床背景下，具有较高的验前概率PJI。需要进一步研究以确定NGS提供临床获益的适应症和亚组。(c)2019爱思唯尔公司All rights reserved.
Background: Periprosthetic joint infection (PJI) after total knee arthroplasty is challenging to diagnose. Compared with culture-based techniques, next-generation sequencing (NGS) is more sensitive for identifying organisms but is also less specific and more expensive. To date, there has been no study comparing the cost-effectiveness of these two methods to diagnose PJI after total knee arthroplasty.Methods: A Markov, state-transition model projecting lifetime costs and quality-adjusted life years (QALYs) was constructed to determine the cost-effectiveness from a societal perspective. The primary outcome was incremental cost-effectiveness ratio, with a willingness-to-pay threshold of $100,000/QALY. Sensitivity analyses were performed to evaluate parameter assumptions.Results: At our base case values, culture was not determined to be cost-effective compared to NGS, with an incremental cost-effectiveness ratio of $422,784 per QALY. One-way sensitivity analyses found NGS to be the cost-effective choice above a pretest probability of 45.5% for PJI. In addition, NGS was cost-effective if its sensitivity was greater than 70.0% and its specificity greater than 94.1%. Two-way sensitivity analyses revealed that the pretest probability and test performance parameters (sensitivity and specificity) were the largest factors for identifying whether a particular strategy was cost-effective.Conclusion: The results of our model suggest that the cost-effectiveness of NGS to diagnose PJI depends primarily on the pretest probability of PJI and the performance characteristics of the NGS technology. Our results are consistent with the idea that NGS should be reserved for clinical contexts with a high pretest probability of PJI. Further study is required to determine the indications and subgroups for which NGS offers clinical benefit. (c) 2019 Elsevier Inc. All rights reserved.