Economic Study of 2-Stage Exchange in Patients With Knee or Hip Prosthetic Joint Infection Managed in a Referral Center in France: Time to Use Innovative(s) Intervention(s) at the Time of Reimplantation to Reduce the Risk of Superinfection
Hassan Serrier,
Christell Julien,
Cécile Batailler,
Eugénie Mabrut,
Corinne Brochier,
Sylvie Thevenon,
Marianne Maynard-Muet,
Agnes Henry,
Sebastien Lustig (),
Laure Huot and
Tristan Ferry ()
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Hassan Serrier: HCL - Hospices Civils de Lyon
Christell Julien: HCL - Hospices Civils de Lyon
Cécile Batailler: LBMC UMR T9406 - Laboratoire de Biomécanique et Mécanique des Chocs - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - Université Gustave Eiffel, Hôpital de la Croix-Rousse [CHU - HCL] - HCL - Hospices Civils de Lyon
Eugénie Mabrut: HCL - Hospices Civils de Lyon
Corinne Brochier: HCL - Hospices Civils de Lyon
Sylvie Thevenon: HCL - Hospices Civils de Lyon
Marianne Maynard-Muet: HCL - Hospices Civils de Lyon
Agnes Henry: HCL - Hospices Civils de Lyon
Sebastien Lustig: LBMC UMR T9406 - Laboratoire de Biomécanique et Mécanique des Chocs - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - Université Gustave Eiffel, HCL - Hospices Civils de Lyon
Laure Huot: HCL - Hospices Civils de Lyon
Tristan Ferry: HCL - Hospices Civils de Lyon, CIRI - Centre International de Recherche en Infectiologie - ENS de Lyon - École normale supérieure de Lyon - Université de Lyon - UCBL - Université Claude Bernard Lyon 1 - Université de Lyon - UJM - Université Jean Monnet - Saint-Étienne - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique
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Abstract:
Objective: Chronic prosthetic joint infections (PJI) are serious complications in arthroplasty leading to prosthesis exchange and potential significant costs for health systems, especially if a subsequent new infection occurs. This study assessed the cost of chronic PJI managed with 2-stage exchange at the Lyon University Hospital, CRIOAc Lyon reference center, France. A threshold analysis was then undertaken to determine the reimbursement tariff of a hypothetical preventive device usable at the time of reimplantation, which possibly enables health insurance to save money according to the risk reduction of subsequent new infection. This analysis was also performed for a potential innovative device already available on the market, a dual antibiotic loaded bone cement used to fix cemented prosthesis that releases high concentrations of gentamicin and vancomycin locally (G+V cement). Method: Patients >18 years, admitted for a hip or knee chronic PJI managed with 2-stage exchange, between January 1, 2013, and December 31, 2015, were retrospectively identified. Following, resource consumption in relation to inpatient hospital stay, hospitalization at home, rehabilitation care, outpatient antibiotic treatments, imaging, laboratory analysis, and consultations were identified and collected from patient records and taken into account in the evaluation. Costs were assessed from the French health insurance perspective over the 2 years following prosthesis reimplantation. Results: The study included 116 patients (median age 67 y; 47% hip prosthesis). Mean cost of chronic PJI was estimated over the 2 years following prosthesis reimplantation at €21,324 for all patients, and at €51,697 and €15,745 for patients with (n = 18) and without (n = 98) a subsequent new infection after reimplantation, respectively. According to the threshold analysis the reimbursement tariff (i) should not exceed €2,820 for a device which can reduce the risk of a new infection by 50% and (ii) was between €2,988 and €3,984 if the G + V cement can reduce the risk of a new infection by 80% (this reduction risk is speculative and has to be confirmed by clinical trials). Conclusion: This study revealed that chronic PJI requiring a 2-stage revision is costly, with significant costs in relation to the reimplantation procedure (about 15 k€). However, following reimplantation the rate of subsequent new infection remained high, and the cost of reimplantation following a new infection is considerable, reaching 50k€ per patient. These first cost estimates of managing chronic PJI with 2-stage exchange in France underline the economic interest of preventing new infections.
Keywords: ANTIBIOTICS; BONE AND JOINT INFECTION; COST ANALYSIS; HEALTHCARE SYSTEM; PREVENTION; PROSTHETIC-JOINT INFECTION; SUPERINFECTION (search for similar items in EconPapers)
Date: 2021
Note: View the original document on HAL open archive server: https://hal.science/hal-03584562v1
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Published in Frontiers in Medicine, 2021, 8, pp.552669. ⟨10.3389/fmed.2021.552669⟩
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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-03584562
DOI: 10.3389/fmed.2021.552669
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