title: Cost-effectiveness of antibiotic prophylaxis for dental patients with prosthetic joints: Comparisons of antibiotic regimens for patients with total hip arthroplasty.
abstract: BACKGROUND
  Clinician uncertainty concerning the need for antibiotic prophylaxis to prevent prosthetic joint infection (PJI) after undergoing dental procedures persists. Improved understanding of the potential clinical and economic risks and benefits of antibiotic prophylaxis will help inform the debate and facilitate the continuing evolution of clinical management guidelines for dental patients with prosthetic joints.
  
  
  METHODS
  The authors developed a Markov decision model to compare the lifetime cost-effectiveness of alternative antibiotic prophylaxis strategies for dental patients aged 65 years who had undergone total hip arthroplasty (THA). On the basis of the authors' interpretation of previous recommendations from the American Dental Association and American Academy of Orthopaedic Surgeons, they compared the following strategies: no prophylaxis, prophylaxis for the first 2 years after arthroplasty, and lifetime prophylaxis.
  
  
  RESULTS
  A strategy of foregoing antibiotic prophylaxis before dental visits was cost-effective and resulted in lower lifetime accumulated costs ($11,909) and higher accumulated quality-adjusted life years (QALYs) (12.375) when compared with alternative prophylaxis strategies.
  
  
  CONCLUSIONS
  The results of Markov decision modeling indicated that a no-antibiotic prophylaxis strategy was cost-effective for dental patients who had undergone THA. These results support the findings of case-control studies and the conclusions of an American Dental Association Council on Scientific Affairs report that questioned general recommendations for antibiotic prophylaxis before dental procedures.
  
  
  CONCLUSIONS
  The results of cost-effectiveness decision modeling support the contention that routine antibiotic prophylaxis for dental patients with total joint arthroplasty should be reconsidered.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Skaar
authors.forename: Taehwan
authors.initials: T
authors.lastname: Park
authors.forename: Marc F
authors.initials: MF
authors.lastname: Swiontkowski
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kuntz
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000191:economics* / Q000379:methods; D019644:Arthroplasty, Replacement, Hip / Q000191:economics; D003362:Cost-Benefit Analysis; D003729:Dental Care / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008390:Markov Chains; D016459:Prosthesis-Related Infections / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D019057:Quality-Adjusted Life Years
chemical_list: D000900:Anti-Bacterial Agents
keywords: Total hip arthroplasty; antibiotic prophylaxis; dental procedures; prosthetic joint infection