NEW YORK — According to a presenter at the Musculoskeletal Infection Society Annual Open Scientific Meeting, routine use of antibiotic-loaded bone cement in patients who underwent primary total knee arthroplasty was not cost effective. Antibiotic-loaded bone cement added $299 in costs and did not decrease the rate of periprosthetic joint infection.
“Routine use of antibiotic cement is not cost effective in preventing infection in primary TKA and should be avoided with value-based alterative payment models that incentivize to reduce unnecessary costs,” Michael Yayac, MD, said during his presentation. “However, given that this was performed in a relatively healthy population at orthopedic specialty hospitals, further studies would be needed to determine [whether] certain high-risk patients would benefit from its use and would be considered a cost-effective measure.”
In a retrospective review, Yayac and colleagues identified 2,511 patients who underwent cemented primary TKAs. Overall, 1,077 patients underwent TKA with antibiotic-loaded bone cement. Demographics, comorbidities, costs and periprosthetic joint infection (PJI) rates were compared between patients who received antibiotic-loaded bone cement with those who received plain cement. Multivariate regression analysis was used to determine the independent impact antibiotic-loaded bone cement had on the PJI rate. Readmission costs for PJI were calculated along with the reduction of PJI needed to justify the added cost of antibiotic-loaded bone cement.
Results showed patients who underwent TKA with antibiotic-loaded bone cement compared with plain cement had no difference in PJI rates or complications. However, patients in the antibiotic-loaded bone cement group had higher cement costs ($416 vs. $117) and overall procedure costs ($6,445 vs. $5,968). Investigators noted the infection rate was not affected by the antibiotic-loaded bone cement. Higher overall 90-day episode of care claims costs were seen in patients readmitted with a PJI.
“Antibiotic cement would have to prevent one infection out one of every 101 patients that it’s used [for] or reduce the rate of PJI by 0.99% in order for it to be considered cost effective,” he said. – by Monica Jaramillo
Courtney PM, et al. The economics of antibiotic cement in total knee arthroplasty: Added cost with no reduction in infection rates. Presented at: Musculoskeletal Infection Society Annual Open Scientific Meeting; Aug. 2-3, 2019; New York.
Disclosure: Yayac reports no relevant financial disclosures.