Cost-Effectiveness of Staphylococcus aureus Decolonization Strategies in High-Risk Total Joint Arthroplasty Patients.
The risk of prosthetic joint infection increases with Staphylococcus aureus colonization. The cost-effectiveness of decolonization is controversial. We evaluated cost-effectiveness decolonization protocols in high-risk arthroplasty patients.



An analytical model evaluated risk under 3 protocols: 4 swabs, 2 swabs, and nasal swab alone. These were compared to no-screening and universal decolonization strategies. Cost-effectiveness was evaluated from the hospital, patient, and societal perspective.



Under base case conditions, universal decolonization and 4-swab strategies were most effective. The 2-swab and universal decolonization strategy were most cost-effective from patient and societal perspectives. From the hospital perspective, universal decolonization was the dominant strategy (much less costly and more effective).



S aureus decolonization may be cost-effective for reducing prosthetic joint infections in high-risk patients. These results may have important implications for treatment of patients and for cost containment in a bundled payment system.
Infectious Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York; Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York.
Devin M
DM
Williams
Infectious Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York.
Andy O
AO
Miller
Infectious Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York.
Michael W
MW
Henry
Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York.
Geoffrey H
GH
Westrich
Healthcare Research Institute, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York.
Hassan M K
HMK
Ghomrawi
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001178:Arthroplasty; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000191:economics; D003362:Cost-Benefit Analysis; D006801:Humans; D017053:Infection Control / Q000191:economics* / Q000379:methods; D055624:Methicillin-Resistant Staphylococcus aureus; D016459:Prosthesis-Related Infections / Q000191:economics / Q000382:microbiology / Q000517:prevention & control*; D013203:Staphylococcal Infections / Q000191:economics / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents
Staphylococcus aureus; arthroplasty; cost-effectiveness; decolonization; prosthetic joint infection; surgical site infection