The Cost-Effectiveness of Wound Dressings for Infection Prophylaxis in Total Joint Arthroplasty: An Economic Evaluation

Abstract

Background Periprosthetic joint infection (PJI) is a medical and economical challenge. Specific post-operative wound dressings have been developed to mitigate risk of PJI following total hip arthroplasty (THA) and total knee arthroplasty (TKA), but these come with added cost and unknown benefit. The purpose of this study was to determine which dressings may be economically justifiable. Methods The average added cost of Xeroform with gauze (Xeroform+gauze), Mepilex Border, Aquacel Ag, and Dermabond Prineo dressings compared to standard dressing (Xeroform+gauze) only were obtained from institutional records and contemporary literature. Baseline infection rates following THA and TKA and average costs of PJI treatment were obtained from the literature. A break-even analysis was utilized to determine the absolute risk reduction (ARR) needed in infection rate to make each dressing cost-effective. Results At $3.00, a single Xeroform+gauze is economically justified if the initial infection rate for TKA (1.10%) and THA (1.62%) are reduced by an ARR of 0.01% and 0.009%, respectively. Two to three additional post-operative dressing changes increases the cost of Xeroform+gauze to $9.00-12.00 and increases the required ARR for TKA to 0.04-0.05% and for THA to 0.028-0.038%. Mepilex Border costs $29.00 and requires an ARR of 0.11% for TKA and 0.09% for THA. Aquacel Ag costs $40.00 and requires an ARR of 0.16% for TKA and 0.13% for THA. Dermabond Prineo costs $79.00 and requires an ARR of 0.31% for TKA and 0.25% for THA. Variations in estimation of initial infection rate did not impact ARR for any dressing type. Conclusions Orthopaedic surgeons have multiple options for surgical dressings following total joint replacement. With respect to infection prophylaxis, Xeroform+gauze is the most cost-effective. Other specialized dressings such as Mepilex Border, Aquacel Ag, or Dermabond Prineo, require significantly higher reductions in infection rate to be economically justifiable.