title: Surgical site infection prevention following total hip arthroplasty in Australia: a cost-effectiveness analysis.
abstract: BACKGROUND
  Surgical site infection (SSI) is associated with substantial costs for health services, reduced quality of life, and functional outcomes. The aim of this study was to evaluate the cost-effectiveness of strategies claiming to reduce the risk of SSI in hip arthroplasty in Australia.
  
  
  METHODS
  Baseline use of antibiotic prophylaxis (AP) was compared with no antibiotic prophylaxis (no AP), antibiotic-impregnated cement (AP + ABC), and laminar air operating rooms (AP + LOR). A Markov model was used to simulate long-term health and cost outcomes of a hypothetical cohort of 30,000 total hip arthroplasty patients from a health services perspective. Model parameters were informed by the best available evidence. Uncertainty was explored in probabilistic sensitivity and scenario analyses.
  
  
  RESULTS
  Stopping the routine use of AP resulted in over Australian dollars (AUD) $1.5 million extra costs and a loss of 163 quality-adjusted life years (QALYs). Using antibiotic cement in addition to AP (AP + ABC) generated an extra 32 QALYs while saving over AUD $123,000. The use of laminar air operating rooms combined with routine AP (AP + LOR) resulted in an AUD $4.59 million cost increase and 127 QALYs lost compared with the baseline comparator.
  
  
  CONCLUSIONS
  Preventing deep SSI with antibiotic prophylaxis and antibiotic-impregnated cement has shown to improve health outcomes among hospitalized patients, save lives, and enhance resource allocation. Based on this evidence, the use of laminar air operating rooms is not recommended.
authors: Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia. k.merollini@qut.edu.au
authors: Katharina M D
authors: KM
authors: Merollini
authors: Ross W
authors: RW
authors: Crawford
authors: Sarah L
authors: SL
authors: Whitehouse
authors: Nicholas
authors: N
authors: Graves
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000191:economics / Q000379:methods; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001315:Australia / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D004780:Environment, Controlled; D005260:Female; D006801:Humans; D017053:Infection Control / Q000191:economics* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control*
keywords: Decision making; Economic evaluation; Infection control; Orthopedics; Surgical wound infection