Extended report
Antibiotic prophylaxis for haematogenous bacterial arthritis in
patients with joint disease: a cost effectiveness analysis
P Krijnena, C J E Kaandorpb, E W Steyerberga, D van Schaardenburgb, H J Bernelot Moensc, J D F Habbemaa
a Center for Clinical
Decision Sciences, Department of Public Health, Erasmus University,
Rotterdam, The Netherlands, b Jan van Breemen Institute
for Rheumatology and Rehabilitation, Amsterdam, The Netherlands, c Medical Spectrum Twente, The Netherlands
Correspondence to: Mrs Krijnen, Center for Clinical Decision Sciences, Department of Public Health, Erasmus University, PO Box 1738, 3000 DR Rotterdam, The Netherlands krijnen{at}mgz.fgg.eur.nl
Accepted for publication 9 August 2000
OBJECTIVE
To assess
the cost effectiveness of antibiotic prophylaxis for haematogenous
bacterial arthritis in patients with joint disease.
METHODSIn a decision
analysis, data from a prospective study on bacterial arthritis in 4907 patients with joint disease were combined with literature data to
assess risks and benefits of antibiotic prophylaxis. Effectiveness and
cost effectiveness calculations were performed on antibiotic
prophylaxis for various patient groups. Grouping was based on
(a) type of event leading to transient
bacteraemiathat is, infections (dermal, respiratory/urinary tract)
and invasive medical proceduresand (b) the
patient's susceptibility to bacterial arthritis which was increased in
the presence of rheumatoid arthritis, large joint prostheses,
comorbidity, and old age.
RESULTSOf the
patients with joint disease, 59% had no characteristics that increased
susceptibility to bacterial arthritis, and 31% had one. For dermal
infections, the effectiveness of antibiotic prophylaxis was maximally
35 quality adjusted life days (QALDs) and the cost effectiveness
maximally $52 000 per quality adjusted life year (QALY). For other
infections, the effectiveness of prophylaxis was lower and the cost
effectiveness higher. Prophylaxis for invasive medical procedures
seemed to be acceptable only in patients with high susceptibility: 1 QALD at a cost of $1300/QALY; however, the results were influenced
substantially when the level of efficacy of the prophylaxis or cost of
prophylactic antibiotics was changed.
CONCLUSIONProphylaxis
seems to be indicated only for dermal infections, and for infections of
the urinary and respiratory tract in patients with increased
susceptibility to bacterial arthritis. Prophylaxis for invasive medical
procedures, such as dental treatment, may only be indicated for
patients with joint disease who are highly susceptible.
© 2001 by Annals of the Rheumatic Diseases
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
-
Uckay, I., Pittet, D., Bernard, L., Lew, D., Perrier, A., Peter, R.
(2008). Antibiotic prophylaxis before invasive dental procedures in patients with arthroplasties of the hip and knee. J Bone Joint Surg Br
90-B: 833-838
[Abstract] [Full Text] -
Brauer, C. A., Rosen, A. B., Olchanski, N. V., Neumann, P. J.
(2005). Cost-Utility Analyses in Orthopaedic Surgery. JBJS
87: 1253-1259
[Abstract] [Full Text]
- Full Text
- Full Text (PDF)
- Submit a response
- Alert me when this article is cited
- Alert me when eLetters are posted
- Alert me if a correction is posted
- Citation Map
Services
- Email this link to a friend
- Similar articles in this journal
- Similar articles in PubMed
- Add article to my folders
- Download to citation manager
- Request Permissions
Citing Articles
Google Scholar
PubMed
Topic Collections
-
Health economics
-
Degenerative joint disease
-
Musculoskeletal syndromes
-
Immunology (including allergy)
-
Connective tissue disease
Bookmark with
Register for free content
The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.
Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.
