Routine use of antibiotic-laden bone cement in total knee arthroplasty is a cost-effective practice in the single-payer healthcare system

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 31; no. 9; pp. 3847 - 3853
• Main Authors: Abdel Khalik, Hassaan, Wood, Thomas J., Tushinski, Daniel M., Gazendam, Aaron, Petruccelli, Danielle T., Bali, Kamal, Winemaker, Mitchell, Avram, Victoria, de Beer, Justin, Williams, Dale, Puri, Laura, Piccirillo, Liz
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2023; Springer Nature B.V
• Subjects: Antibiotics; Arthroplasty (knee); Bone cements; Bone implants; Cement; Cost analysis; Effectiveness; Health care; Joint replacement surgery; Knee; Medicine; Medicine & Public Health; Orthopedics; Polymethyl methacrylate; Sensitivity analysis; Sports Medicine; Utilities; Total knee arthroplasty; Periprosthetic joint infection; Health economics; Antibiotic-laden bone cement; Surgical site infection; Cost-utility analysis; Infection prophylaxis; Cost-effectiveness
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-023-07364-5

Purpose The purpose of this study was to determine the cost-effectiveness of antibiotic-laden bone cement (ALBC) in primary total knee arthroplasty (TKA) from the perspective of a single-payer healthcare system. Methods A cost-utility analysis (CUA) was performed over a 2-year time horizon comparing primary TKA with either ALBC or regular bone cement (RBC) from the perspective of the single-payer Canadian healthcare system. All costs were in 2020 Canadian dollars. Health utilities were in the form of quality-adjusted life years (QALYs). Model inputs for cost, utilities and probabilities were derived from the literature as well as regional and national databases. One-way deterministic sensitivity analysis was performed. Results Primary TKA with ALBC was found to be more cost-effective compared to primary TKA with RBC with an incremental cost-effectiveness ratio (ICER) of -3,637.79 CAD/QALY. The use of routine ALBC remained cost-effective even with cost increases of up to 50% per bag of ALBC. TKA with ALBC was no longer cost-effective if the rate of PJI following this practice increased 52%, or the rate of PJI following the use of RBC decreased 27%. Conclusions The routine use of ALBC in TKA is a cost-effective practice in the single-payer Canadian healthcare system. This remains to be the case even with a 50% increase in the cost of ALBC. Policy makers and hospital administrators of single-payer healthcare systems can leverage this model to inform their local funding policies. Future prospective reviews and randomized controlled trials from the perspective of various healthcare models can further shed light on this issue. Level of evidence III.