While surgeons should keep in mind the development of future antimicrobial resistance, results showed extended oral antibiotic prophylaxis is a cost-effective option for reducing prosthetic joint infection after total joint arthroplasty.
Researchers used a break-even economic model to calculate the absolute risk reduction (ARR) in infection rate necessary for extended oral antibiotic prophylaxis to be cost-effective for high-risk patients undergoing total hip arthroplasty or total knee arthroplasty. Based on institutional purchasing records, the cost of a 7-day course of cefadroxil was $52.08; Bactrim DS (a combination of sulfamethoxazole and trimethoprim) was $1.54; and clindamycin was $6.72.
With an initial infection rate of 2.1% and PJI treatment cost of $27,870 for TKAs, extended oral antibiotic prophylaxis with cefadroxil was cost-effective at an ARR of 0.187%. With an initial infection rate of 4.3% and PJI treatment cost of $34,445 for THAs, extended oral antibiotic prophylaxis with cefadroxil was cost-effective at an ARR of 0.151%. Researchers noted the ARR needed to achieve cost-effectiveness was even lower for extended oral antibiotic prophylaxis with a combination of sulfamethoxazole and trimethoprim and clindamycin.
Researchers concluded that the cost-effectiveness of extended oral antibiotic prophylaxis for reducing PJI after TJA was preserved – even with varying costs of antibiotic regimens, PJI treatment costs and infection rates.
“Physicians and health care institutions can employ this model to determine if this intervention is cost-effective for their specific practice,” the researchers wrote in the study. “However, the current evidence supporting this practice is limited in quality and the cost-effectiveness of this practice should be weighed against the possibility of future developing antimicrobial resistance, which may change the value proposition and requires future investigation,” they added.