Surgical site infection prevention following total hip arthroplasty in Australia: A cost-effectiveness analysis

• Published in: American journal of infection control 2013-09, Vol.41 (9), p.803-809
• Main Authors: Merollini, Katharina M.D., PhD, Crawford, Ross W., FRACS, PhD, Whitehouse, Sarah L., PhD, Graves, Nicholas, PhD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antibiotic Prophylaxis - economics; Antibiotic Prophylaxis - methods; Antibiotics; Arthroplasty, Replacement, Hip - adverse effects; Australia - epidemiology; Benefit cost analysis; Biological and medical sciences; Cost-Benefit Analysis; Decision making; Economic evaluation; Environment, Controlled; Epidemiology. Vaccinations; Female; General aspects; Hip joint; Human infectious diseases. Experimental studies and models; Humans; Infection Control; Infection Control - economics; Infection Control - methods; Infectious Disease; Infectious diseases; Inpatient care; Joint surgery; Male; Medical sciences; Middle Aged; Orthopedic surgery; Orthopedics; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical outcomes; Surgical wound infection; Surgical Wound Infection - economics; Surgical Wound Infection - epidemiology; Surgical Wound Infection - prevention & control
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2012.11.015

Background Surgical site infection (SSI) is associated with substantial costs for health services, reduced quality of life, and functional outcomes. The aim of this study was to evaluate the cost-effectiveness of strategies claiming to reduce the risk of SSI in hip arthroplasty in Australia. Methods Baseline use of antibiotic prophylaxis (AP) was compared with no antibiotic prophylaxis (no AP), antibiotic-impregnated cement (AP + ABC), and laminar air operating rooms (AP + LOR). A Markov model was used to simulate long-term health and cost outcomes of a hypothetical cohort of 30,000 total hip arthroplasty patients from a health services perspective. Model parameters were informed by the best available evidence. Uncertainty was explored in probabilistic sensitivity and scenario analyses. Results Stopping the routine use of AP resulted in over Australian dollars (AUD) $1.5 million extra costs and a loss of 163 quality-adjusted life years (QALYs). Using antibiotic cement in addition to AP (AP + ABC) generated an extra 32 QALYs while saving over AUD $123,000. The use of laminar air operating rooms combined with routine AP (AP + LOR) resulted in an AUD $4.59 million cost increase and 127 QALYs lost compared with the baseline comparator. Conclusion Preventing deep SSI with antibiotic prophylaxis and antibiotic-impregnated cement has shown to improve health outcomes among hospitalized patients, save lives, and enhance resource allocation. Based on this evidence, the use of laminar air operating rooms is not recommended.