No 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.

No abstract

ObjectivesCardiac surgery has seen substantial scientific progress over recent decades. Health economic evaluations have become important tools for decision makers to prioritize scarce health resources. The present study aimed to identify and critically appraise the reporting quality of health economic evaluations conducted in the field of cardiac surgery.MethodsA literature search was performed to identify health economic evaluations in cardiac surgery. The consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement was used to assess the quality of reporting of studies.ResultsA total 4,705 articles published between 1981 and 2016 were identified; sixty-nine studies fulfilled the inclusion criteria. There was a trend toward a greater number of publications and reporting quality over time. Six (8.7 percent) studies were conducted between 1981 and 1990, nine (13 percent) between 1991 and 2000, twenty-four (34.8 percent) between 2001 and 2010, and thirty (43.5 percent) after 2011. The mean CHEERS score of all articles was 16.7/24; for those published between 1980 and 1990 the mean (SD) score was 10.2 (±1.4), for those published between 1991 and 2000 it was 11.2 (±2.4), between 2001 and 2010 it was 15.3 (±4.8), and after 2011 it was 19.9 (±2.9). The quality of reporting was still insufficient for several studies after 2000, especially concerning items “characterizing heterogeneity,” “assumptions,” and “choice of model.”ConclusionsThe present study suggests that, even if the quantity and the quality of health economics evaluation in cardiac surgery has increased, there remains a need for improvement in several reporting criteria to ensure greater transparency.

Objectives: To evaluate the cost-effectiveness of radiofrequency catheter ablation (RFCA) using contact-force catheter (Thermocool SmartTouch ® ) + warfarin versus antiarrhythmic drugs (AAD) + new oral anticoagulants (NOAC) in paroxysmal atrial fibrillation (PAF) patients from third-party payer's perspective in China. Methods: A two-part model was developed to estimate the cost-effectiveness of these two treatments. The short-term part was a decision-tree (1 year) including surgeryrelated complications and drug toxicity. The long-term was a Markov chain (lifetime) including the health states of normal sinus rhythms, AF recurrence, heart failure, stroke, post stroke, intracranial hemorrhages (ICH), post ICH, myocardial Infarction (MI), post MI, gastrointestinal bleeding and dead. Clinical efficacy, utility and cost data were obtained from published literature. The model calculated quality-adjusted life-years (QALYs) and total costs per patient. One-way and probabilistic sensitivity analyses were conducted. Results: Captured by lifetime Markov model plus 1-year decision tree model, the total costs per patient for RFCA vs. AAD groups were U107,497 vs. U149,764; QALYs 8.16 vs. 7.58. From the 7 th year, RFCA + warfarin became cost-effective (the incremental cost-effectiveness ratios at 7 th year was U98,579/QALY, lower than the recommended threshold, 3xGDP/capita in China, U178,980). Furthermore, RFCA became cost-saving from the 9 th year till lifetime with better effectiveness and lower overall costs compared with AAD. Both one-way and probabilistic sensitivity analyses confirmed the robustness of the results. Conclusions: Compared with AAD + NOAC, RFCA using contact force catheter + warfarin is cost-saving in long term for the treatment of PAF in China.