Cost-effectiveness of Single vs Double Debridement and Implant Retention for Acute Periprosthetic Joint Infections in Total Knee Arthroplasty: A Markov Model

Background: Periprosthetic joint infection (PJI) is a common cause of revision total knee surgery. Although debridement and implant retention (DAIR) has lower success rates in the chronic setting, it is an accepted treatment of acute PJI, whether postoperatively or with late hematogenous seeding. Th...

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Autores principales:	Joseph K. Antonios, MD, Kevin J. Bozic, MD, MBA, Henry D. Clarke, MD, Mark J. Spangehl, MD, Joshua S. Bingham, MD, Adam J. Schwartz, MD, MBA
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Total knee arthroplasty Acute periprosthetic joint infection Debridement and implant retention Failed total knee arthroplasty Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/1bc091f7a9464aa49b4eaeebc5888077
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spelling	oai:doaj.org-article:1bc091f7a9464aa49b4eaeebc58880772021-11-14T04:34:00ZCost-effectiveness of Single vs Double Debridement and Implant Retention for Acute Periprosthetic Joint Infections in Total Knee Arthroplasty: A Markov Model2352-344110.1016/j.artd.2021.08.009https://doaj.org/article/1bc091f7a9464aa49b4eaeebc58880772021-10-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2352344121001503https://doaj.org/toc/2352-3441Background: Periprosthetic joint infection (PJI) is a common cause of revision total knee surgery. Although debridement and implant retention (DAIR) has lower success rates in the chronic setting, it is an accepted treatment of acute PJI, whether postoperatively or with late hematogenous seeding. There are two broad DAIR strategies: single debridement and planned double debridement. The purpose of this study is to evaluate the cost-effectiveness of single vs double DAIR for acute PJI in total knee arthroplasty. Methods: A decision tree using single or double DAIR as the treatment strategy for acute PJI was constructed. Quality-adjusted life years and costs associated with the two treatment arms were calculated. Treatment success rates, failure rates, and mortality rates were derived from the literature. Medical costs were derived from both the literature and Medicare data. A cost-effectiveness plane was constructed from multiple Monte Carlo trials. A sensitivity analysis identified parameters most influencing the optimal strategy decision. Results: Double DAIR was the optimal treatment strategy both in terms of the health utility state (82% of trials) and medical cost (97% of trials). Strategy tables demonstrated that as long as the success rate of double debridement is 10% or greater than the success rate of a single debridement, the two-stage protocol is cost-effective. Conclusions: A double DAIR protocol is more cost-effective than single DAIR from a societal perspective.Joseph K. Antonios, MDKevin J. Bozic, MD, MBAHenry D. Clarke, MDMark J. Spangehl, MDJoshua S. Bingham, MDAdam J. Schwartz, MD, MBAElsevierarticleTotal knee arthroplastyAcute periprosthetic joint infectionDebridement and implant retentionFailed total knee arthroplastyOrthopedic surgeryRD701-811ENArthroplasty Today, Vol 11, Iss , Pp 187-195 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Total knee arthroplasty Acute periprosthetic joint infection Debridement and implant retention Failed total knee arthroplasty Orthopedic surgery RD701-811
spellingShingle	Total knee arthroplasty Acute periprosthetic joint infection Debridement and implant retention Failed total knee arthroplasty Orthopedic surgery RD701-811 Joseph K. Antonios, MD Kevin J. Bozic, MD, MBA Henry D. Clarke, MD Mark J. Spangehl, MD Joshua S. Bingham, MD Adam J. Schwartz, MD, MBA Cost-effectiveness of Single vs Double Debridement and Implant Retention for Acute Periprosthetic Joint Infections in Total Knee Arthroplasty: A Markov Model
description	Background: Periprosthetic joint infection (PJI) is a common cause of revision total knee surgery. Although debridement and implant retention (DAIR) has lower success rates in the chronic setting, it is an accepted treatment of acute PJI, whether postoperatively or with late hematogenous seeding. There are two broad DAIR strategies: single debridement and planned double debridement. The purpose of this study is to evaluate the cost-effectiveness of single vs double DAIR for acute PJI in total knee arthroplasty. Methods: A decision tree using single or double DAIR as the treatment strategy for acute PJI was constructed. Quality-adjusted life years and costs associated with the two treatment arms were calculated. Treatment success rates, failure rates, and mortality rates were derived from the literature. Medical costs were derived from both the literature and Medicare data. A cost-effectiveness plane was constructed from multiple Monte Carlo trials. A sensitivity analysis identified parameters most influencing the optimal strategy decision. Results: Double DAIR was the optimal treatment strategy both in terms of the health utility state (82% of trials) and medical cost (97% of trials). Strategy tables demonstrated that as long as the success rate of double debridement is 10% or greater than the success rate of a single debridement, the two-stage protocol is cost-effective. Conclusions: A double DAIR protocol is more cost-effective than single DAIR from a societal perspective.
format	article
author	Joseph K. Antonios, MD Kevin J. Bozic, MD, MBA Henry D. Clarke, MD Mark J. Spangehl, MD Joshua S. Bingham, MD Adam J. Schwartz, MD, MBA
author_facet	Joseph K. Antonios, MD Kevin J. Bozic, MD, MBA Henry D. Clarke, MD Mark J. Spangehl, MD Joshua S. Bingham, MD Adam J. Schwartz, MD, MBA
author_sort	Joseph K. Antonios, MD
title	Cost-effectiveness of Single vs Double Debridement and Implant Retention for Acute Periprosthetic Joint Infections in Total Knee Arthroplasty: A Markov Model
title_short	Cost-effectiveness of Single vs Double Debridement and Implant Retention for Acute Periprosthetic Joint Infections in Total Knee Arthroplasty: A Markov Model
title_full	Cost-effectiveness of Single vs Double Debridement and Implant Retention for Acute Periprosthetic Joint Infections in Total Knee Arthroplasty: A Markov Model
title_fullStr	Cost-effectiveness of Single vs Double Debridement and Implant Retention for Acute Periprosthetic Joint Infections in Total Knee Arthroplasty: A Markov Model
title_full_unstemmed	Cost-effectiveness of Single vs Double Debridement and Implant Retention for Acute Periprosthetic Joint Infections in Total Knee Arthroplasty: A Markov Model
title_sort	cost-effectiveness of single vs double debridement and implant retention for acute periprosthetic joint infections in total knee arthroplasty: a markov model
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/1bc091f7a9464aa49b4eaeebc5888077
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Cost-effectiveness of Single vs Double Debridement and Implant Retention for Acute Periprosthetic Joint Infections in Total Knee Arthroplasty: A Markov Model

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