Cost-Effectiveness of Antibiotic-Impregnated Bone Cement Used in Primary Total Hip Arthroplasty

作者：Justin S. Cummins, Ivan M. Tomek, Stephen Kantor, Ove Furnes, Lars B. Engesæter, Samuel R.G. Finlayson · 发表于：Journal of Bone and Joint Surgery · 年份：2009 · DOI：10.2106/jbjs.g.01029 · 被引用次数：92 · 研究领域：Orthopedic Infections and Treatments、Orthopaedic implants and arthroplasty、Total Knee Arthroplasty Outcomes

BACKGROUND: Antibiotic-impregnated bone cement is infrequently used in the United States for primary total hip arthroplasty because of concerns about cost, performance, and the possible development of antibiotic resistance and because it has been approved only for use in revision arthroplasty after infection. The purpose of this study was to model the use of antibiotic-impregnated bone cement in primary total hip arthroplasty for the treatment of osteoarthritis to determine whether use of the cement is cost-effective when compared with the use of cement without antibiotics. METHODS: To evaluate the cost-effectiveness of each strategy, we used a Markov decision model to tabulate costs and quality-adjusted life years (QALYs) accumulated by each patient. Rates of revision due to infection and aseptic loosening were estimated from data in the Norwegian Arthroplasty Register and were used to determine the probability of undergoing a revision arthroplasty because of either infection or aseptic loosening. The primary outcome measure was either all revisions or revision due to infection. Perioperative mortality rates, utilities, and disutilities were estimated from data in the arthroplasty literature. Costs for primary arthroplasty were estimated from data on in-hospital resource use in the literature. The additional cost of using antibiotic-impregnated bone cement ($600) was then added to the average cost of the initial procedure ($21,654). RESULTS: When all revisions were considere...