Antibiotic prophylaxis for haematogenous bacterial arthritis in patients with joint disease: a cost effectiveness analysis

Abstract

Objective-To assess the cost eVectiveness of antibiotic prophylaxis for haematogenous bacterial arthritis in patients with joint disease. Methods-In a decision analysis, data from a prospective study on bacterial arthritis in 4907 patients with joint disease were combined with literature data to assess risks and benefits of antibiotic prophylaxis. EVectiveness and cost eVectiveness calculations were performed on antibiotic prophylaxis for various patient groups. Grouping was based on (a) type of event leading to transient bacteraemiathat is, infections (dermal, respiratory/ urinary tract) and invasive medical procedures-and (b) the patient's susceptibility to bacterial arthritis which was increased in the presence of rheumatoid arthritis, large joint prostheses, comorbidity, and old age. Results-Of the patients with joint disease, 59% had no characteristics that increased susceptibility to bacterial arthritis, and 31% had one. For dermal infections, the eVectiveness of antibiotic prophylaxis was maximally 35 quality adjusted life days (QALDs) and the cost eVectiveness maximally $52 000 per quality adjusted life year (QALY). For other infections, the eVectiveness of prophylaxis was lower and the cost eVectiveness higher. Prophylaxis for invasive medical procedures seemed to be acceptable only in patients with high susceptibility: 1 QALD at a cost of $1300/QALY; however, the results were influenced substantially when the level of eYcacy of the prophylaxis or cost of prophylactic antibiotics was changed. Conclusion-Prophylaxis seems to be indicated only for dermal infections, and for infections of the urinary and respiratory tract in patients with increased

Relationship Between Perioperative Urinary Tract Infection and Deep Infection After Joint Arthroplasty

“…Our data suggested no clear evidence between postoperative UTI and joint infection, which is consistent with the literature [22,24,36,41]. The majority of bacteria we observed were not enteric pathogens.…”

Antibiotic prophylaxis before invasive dental procedures in patients with arthroplasties of the hip and knee

“…65 An analysis from The Netherlands concluded that for some patients with joint disease, but not with joint replacements, antibiotic prophylaxis before dental work was likely to be cost-effective. 85 In 1997, the American Dental Association and the American Academy of Orthopedic Surgeons issued an advisory statement 5,86 which was updated in 2003, together with the provision of an information leaflet for patients. 68 They stated that antibiotic prophylaxis is not mandatory for routine dental procedures in most patients with joint replacements, but should be considered in those with an increased risk, including joint replacement within the past two years, previous infection of a joint replacement, inflammatory arthritis, type-1 diabetes mellitus, haemophilia, immunosuppression, a history of previous or current malignancy, dental extractions, periodontal procedures, dental implantation, root canal work, descaling if bleeding was anticipated, specialised injections of local anaesthetic, or placement of orthodontic bands.…”

“…Second, infected foci elsewhere in the body 69 must be treated first. 5,6,8,13,20,24,33,66,80,84,85,94 Finally, all patients should be advised to establish and maintain good oral health.…”

Cost‐effectiveness analysis of burning mouth syndrome therapy

“…The baseline scenario included direct healthcare costs in Spain, with inclusion of data drawn from the scientific literature (26), and Spanish drug directory (27). According to guidelines for economic evaluations, as well as commonly published cost‐effectiveness studies, cost‐effectiveness analysis should include direct costs, not only drug costs for maintenance treatment but also costs of associated contacts with healthcare professionals, such as doctors’ or nurses’ time, costs of the prescription and other intervention costs (28–34). Thus, the model included the costs of a 30‐minute outpatient visit to a general dentist for prescription of treatment and recommendations and of each of the drugs evaluated during the therapy period.…”