Economic study of 2-stage exchange in patients with knee or hip prosthetic joint infection managed in a reference center in France: time to use innovative(s) intervention(s) at the time of reimplantation to reduce the risk of superinfection
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).
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.
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 e21,324 for all patients, and at e51,697 and e15,745 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 e2,820 for a
device which can reduce the risk of a new infection by 50% and (ii) was between e2,988
and e3,984 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).
This study revealed that chronic PJI requiring a 2-stage revision is costly,
with significant costs in relation to the reimplantation procedure (about 15 ke). However,
following reimplantation the rate of subsequent new infection remained high, and the cost
of reimplantation following a new infection is considerable, reaching 50ke per patient.
These first cost estimates of managing chronic PJI with 2-stage exchange in France
underline the economic interest of preventing new infections