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J Arthroplasty. 2018 Jun;33(6):1656-1662. doi: 10.1016/j.arth.2018.01.057. Epub 2018 Feb 10.

Economic Evaluation of Antibacterial Coatings on Healthcare Costs in First Year Following Total Joint Arthroplasty.

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Department of Economics, Università Commerciale Luigi Bocconi, Milan, Italy; Department of Environmental Science and Policy, Università degli Studi di Milano, Milan, Italy.
Musculoskeletal Sciences and Technology Lab, Department of Surgery and Cancer, Imperial College London, London, UK.
Università degli Studi di Milano - IRCCS Istituto Ortopedico Galeazzi, U.O. di Ortopedia Pediatrica, Medico Specializzando, Milan, Italy.
Centre for Reconstructive Surgery and Osteo-Articular Infections C.R.I.O. Unit, IRCCS Galeazzi Institute, Milan, Italy.
Laboratory of Clinical-Chemistry and Microbiology, IRCCS Galeazzi Institute, and SCIBIS Department, University of Milan, Milan, Italy.



Antibacterial coatings (ABCs) of implants have proven safe and effective to reduce postsurgical infection, but little is known about their possible economic impact on large-scale use. This study evaluated the point of economic balance, during the first year after surgery, and the potential overall annual healthcare cost savings of 3 different antibacterial technologies applied to joint arthroplasty: a dual-antibiotic-loaded bone cement (COPAL G + C), an antibacterial hydrogel coating (DAC), and a silver coating (Agluna).


The variables included in the algorithm were average cost and number of primary joint arthroplasties; average cost per patient of the ABC; incidence of periprosthetic joint infections and expected reduction using the ABCs; average cost of infection treatment and expected number of cases.


The point of economic balance for COPAL G + C, DAC, and Agluna in the first year after surgery was reached in patient populations with an expected postsurgical infection rate of 1.5%, 2.6%, and 19.2%, respectively. If applied on a national scale, in a moderately high-risk population of patients with a 5% expected postsurgical infection rate, COPAL G + C and DAC hydrogel would provide annual direct cost savings of approximately €48,800,000 and €43,200,000 (€1220 and €1080 per patient), respectively, while the silver coating would be associated with an economic loss of approximately €136,000,000.


This economic evaluation shows that ABC technologies have the potential to decrease healthcare costs primarily by decreasing the incidence of surgical site infections, provided that the technology is used in the appropriate risk class of patients.


antibacterial; arthroplasty; coating; cost; economics; infection

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