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J Hosp Infect. 2013 Nov;85(3):213-9. doi: 10.1016/j.jhin.2013.07.012. Epub 2013 Sep 4.

Factors influencing the cost of prosthetic joint infection treatment.

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1
Department of Surgery, St Vincent's Hospital Melbourne, University of Melbourne, Victoria 3065, Australia; Department of Infectious Diseases, St Vincent's Hospital Melbourne, Victoria, Australia; Department of Orthopaedic Surgery, St Vincent's Hospital Melbourne, Victoria, Australia. Electronic address: tnpeel@unimelb.edu.au.

Abstract

BACKGROUND:

Prosthetic joint infection (PJI) is associated with significant costs to the healthcare system. Current literature examines the cost of specific treatment modalities without assessing other cost drivers for PJI.

AIMS:

To examine the overall cost of the treatment of PJI and to identify factors associated with management costs.

METHODS:

The costs of treatment of prosthetic joint infections were examined in 139 patients across 10 hospitals over a 3-year period (January 2006 to December 2008). Cost calculations included hospitalization costs, surgical costs, hospital-in-the-home costs and antibiotic therapy costs. Negative binomial regression analysis was performed to model factors associated with total cost.

FINDINGS:

The median cost of treating prosthetic joint infection per patient was Australian $34,800 (interquartile range: 20,305, 56,929). The following factors were associated with increased treatment costs: septic revision arthroplasty (67% increase in treatment cost; P = 0.02), hypotension at presentation (70% increase; P = 0.03), polymicrobial infections (41% increase; P = 0.009), surgical treatment with one-stage exchange (100% increase; P = 0.002) or resection arthroplasty (48% increase; P = 0.001) were independently associated with increased treatment costs. Culture-negative prosthetic joint infections were associated with decreased costs (29% decrease in treatment cost; P = 0.047). Treatment failure was associated with 156% increase in treatment costs.

CONCLUSIONS:

This study identifies clinically important factors influencing treatment costs that may be of relevance to policy-makers, particularly in the setting of hospital reimbursement and guiding future research into cost-effective preventive strategies.

KEYWORDS:

Costs; Prosthetic joint infection; Treatment

PMID:
24011668
DOI:
10.1016/j.jhin.2013.07.012
[Indexed for MEDLINE]
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