首选替代方案的隐性成本：全膝关节置换术中血栓预防和人工关节感染预防的财务模型

IF 1.5 Q3 ORTHOPEDICS

Journal of orthopaedics Pub Date : 2024-11-01 DOI:10.1016/j.jor.2024.10.053

Victoria E. Bergstein, Walter L. Taylor IV, Aaron I. Weinblatt, William J. Long

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引用次数: 0

摘要

背景在全膝关节置换术（TKA）后的血栓预防方面，阿司匹林已被证明比 Xa 因子抑制剂同样有效或更有效。在预防 TKA 术后假体关节感染（PJI）方面，头孢唑啉已被证明比万古霉素更有效。本研究旨在比较不同药物组合在预防 TKA 术后静脉血栓栓塞（VTE）和 PJI 方面的成本，重点关注与 PJI 处理相关的成本。方法我们使用了已公布的 PJI 发生率，这些发生率针对接受阿司匹林或 Xa 因子抑制剂血栓预防治疗的 TKA 患者，以及接受头孢唑啉或万古霉素预防治疗的患者。每种药物的单价以及万古霉素用药的相关人工成本均来自本医院的药房服务。PJI 成本模型包括两阶段化脓性 TKA 翻修术的价格和对未来 TKA 数量的全国预测。结果阿司匹林和头孢唑啉的组合平均每位患者成本最低，在 PJI 发生率为 0.8% 的情况下为 521.19 美元。在 PJI 发生率为 1.8% 的情况下，Xa 因子抑制剂和万古霉素的组合平均每位患者成本最昂贵，相当于 5,714.96 美元。结论Xa因子抑制剂和万古霉素联合使用的每名患者平均成本比阿司匹林和头孢唑啉联合使用高出 711%。在这个以价值为基础的医疗时代，阿司匹林和头孢唑啉应被视为TKA血栓预防和PJI预防的黄金标准，因为它们既能降低成本，又能改善患者预后。

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Hidden costs of first choice alternatives: A financial model of thromboprophylaxis and prosthetic joint infection prophylaxis in total knee arthroplasty

Background

Aspirin has been shown to be equally or more effective than factor Xa inhibitors for thromboprophylaxis following total knee arthroplasty (TKA). Cefazolin has been proven more effective than vancomycin in preventing prosthetic joint infection (PJI) after TKA. This study aimed to compare costs between different drug combinations for prevention of venous thromboembolism (VTE) and PJI following TKA, focusing on costs associated with PJI management.

Methods

We used published PJI rates for TKA patients treated with aspirin or factor Xa inhibitors for thromboprophylaxis, as well as for those who received prophylactic cefazolin or vancomycin. Unit prices for each drug and labor costs associated with vancomycin administration were obtained from our hospital's pharmacy service. The PJI cost model included the price of 2-stage septic TKA revision and national projections of future TKA volume.

Results

The least expensive average per-patient cost resulted from the combination of aspirin and cefazolin, equating to $521.19 given a 0.8 % PJI rate. The most expensive average per-patient cost was the combination of a factor Xa inhibitor and vancomycin, equaling $5,714.96 given a 1.8 % PJI rate. This extrapolates to an annual cost burden of $19.5 billion by 2040.

Conclusion

The average per-patient cost of using a combination of a factor Xa inhibitor and vancomycin is 711 % greater than the combination of aspirin and cefazolin. In this era of value-based care, aspirin and cefazolin should be considered gold standards for TKA thromboprophylaxis and PJI prophylaxis, as they reduce costs and improve patient outcomes.

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来源期刊

Journal of orthopaedics ORTHOPEDICS-

CiteScore

3.50

自引率

6.70%

发文量

202

审稿时长

56 days

期刊介绍： Journal of Orthopaedics aims to be a leading journal in orthopaedics and contribute towards the improvement of quality of orthopedic health care. The journal publishes original research work and review articles related to different aspects of orthopaedics including Arthroplasty, Arthroscopy, Sports Medicine, Trauma, Spine and Spinal deformities, Pediatric orthopaedics, limb reconstruction procedures, hand surgery, and orthopaedic oncology. It also publishes articles on continuing education, health-related information, case reports and letters to the editor. It is requested to note that the journal has an international readership and all submissions should be aimed at specifying something about the setting in which the work was conducted. Authors must also provide any specific reasons for the research and also provide an elaborate description of the results.