Ivan Tomek

Cost-effectiveness of unicompartmental and total knee arthroplasty in elderly low-demand patients. A Markov decision analysis.

BACKGROUND Interest in unicompartmental knee arthroplasty has recently increased in the United States, making a firm understanding of the indications for this procedure important. The purpose of this study was to examine the cost-effectiveness of unicompartmental knee arthroplasty compared with total knee arthroplasty in elderly low-demand patients. METHODS A Markov decision model was used to evaluate the cost-effectiveness of unicompartmental knee arthroplasty as compared with total knee arthroplasty in the elderly population. Transition probabilities were estimated from the Norwegian Arthroplasty Register and the arthroplasty literature, and costs were based on the average Medicare reimbursement for unicompartmental, tricompartmental, and revision knee arthroplasties. Outcomes were measured in quality-adjusted life-years. RESULTS Our model showed unicompartmental knee arthroplasty to be a cost-effective strategy for this population as long as the annual probability of revision is <4%. The cost of unicompartmental knee arthroplasty must be greater than

Cost-Effectiveness of Preoperative Nasal Mupirocin Treatment in Preventing Surgical Site Infection in Patients Undergoing Total Hip and Knee Arthroplasty: A Cost-Effectiveness Analysis

13,500 or the cost of total knee arthroplasty must be less than

Cost-Effectiveness of Antibiotic-Impregnated Bone Cement Used in Primary Total Hip Arthroplasty

8500 before total knee arthroplasty becomes more cost-effective. CONCLUSIONS Our model suggests that, on the basis of currently available cost and outcomes data, unicompartmental knee arthroplasty and total knee arthroplasty have similar cost-effectiveness profiles in the elderly low-demand patient population. However, several important parameters that could alter the cost-effectiveness analysis were identified; these included implant survival rates, costs, perioperative mortality and infection rates, and utility values achieved with each procedure. The thresholds identified in this study may help decision-makers to evaluate the cost-effectiveness of each strategy as further research characterizes the variables associate with unicompartmental and total knee arthroplasties and may be helpful for designing future appropriate clinical trials.

Interleukin-1 beta induction of matrix metalloproteinase-1 transcription in chondrocytes requires ERK-dependent activation of CCAAT enhancer-binding protein-beta

OBJECTIVE To perform a cost-effectiveness analysis to evaluate preoperative use of mupirocin in patients with total joint arthroplasty (TJA). DESIGN Simple decision tree model. SETTING Outpatient TJA clinical setting. PARTICIPANTS Hypothetical cohort of patients with TJA. INTERVENTIONS A simple decision tree model compared 3 strategies in a hypothetical cohort of patients with TJA: (1) obtaining preoperative screening cultures for all patients, followed by administration of mupirocin to patients with cultures positive for Staphylococcus aureus; (2) providing empirical preoperative treatment with mupirocin for all patients without screening; and (3) providing no preoperative treatment or screening. We assessed the costs and benefits over a 1-year period. Data inputs were obtained from a literature review and from our institutions internal data. Utilities were measured in quality-adjusted life-years, and costs were measured in 2005 US dollars. MAIN OUTCOME MEASURE Incremental cost-effectiveness ratio. RESULTS The treat-all and screen-and-treat strategies both had lower costs and greater benefits, compared with the no-treatment strategy. Sensitivity analysis revealed that this result is stable even if the cost of mupirocin was over

Decision quality instrument for treatment of hip and knee osteoarthritis: a psychometric evaluation

100 and the cost of SSI ranged between

Management of Chronic Pain: Improving shared decision making in osteoarthritis.

26,000 and

The use of magnetic resonance imaging to evaluate the accuracy of a handheld ultrasound machine in localizing the sciatic nerve in the popliteal fossa.

250,000. Treating all patients remains the best strategy when the prevalence of S. aureus carriers and surgical site infection is varied across plausible values as well as when the prevalence of mupirocin-resistant strains is high. CONCLUSIONS Empirical treatment with mupirocin ointment or use of a screen-and-treat strategy before TJA is performed is a simple, safe, and cost-effective intervention that can reduce the risk of SSI. S. aureus decolonization with nasal mupirocin for patients undergoing TJA should be considered. LEVEL OF EVIDENCE Level II, economic and decision analysis.

Metal Transfer on a Ceramic Head With a Single Rim Contact

BACKGROUND Antibiotic-impregnated bone cement is infrequently used in the United States for primary total hip arthroplasty because of concerns about cost, performance, and the possible development of antibiotic resistance and because it has been approved only for use in revision arthroplasty after infection. The purpose of this study was to model the use of antibiotic-impregnated bone cement in primary total hip arthroplasty for the treatment of osteoarthritis to determine whether use of the cement is cost-effective when compared with the use of cement without antibiotics. METHODS To evaluate the cost-effectiveness of each strategy, we used a Markov decision model to tabulate costs and quality-adjusted life years (QALYs) accumulated by each patient. Rates of revision due to infection and aseptic loosening were estimated from data in the Norwegian Arthroplasty Register and were used to determine the probability of undergoing a revision arthroplasty because of either infection or aseptic loosening. The primary outcome measure was either all revisions or revision due to infection. Perioperative mortality rates, utilities, and disutilities were estimated from data in the arthroplasty literature. Costs for primary arthroplasty were estimated from data on in-hospital resource use in the literature. The additional cost of using antibiotic-impregnated bone cement (

Launching a virtual decision lab: development and field-testing of a web-based patient decision support research platform

600) was then added to the average cost of the initial procedure (

Factors Associated with the Quality of Patients' Surgical Decisions for Treatment of Hip and Knee Osteoarthritis

21,654). RESULTS When all revisions were considered to be the primary outcome measure, the use of antibiotic-impregnated bone cement was found to result in a decrease in overall cost of