Tuesday, October 18, 2016

Topical Vancomycin as infection prophylaxis in shoulder arthroplasty

The cost effectiveness of vancomycin for preventing infections after shoulder arthroplasty: a break-even analysis.

These authors collected cost data for infection-related care of 16 patients treated for deep periprosthetic shoulder infection. They developed and applied an equation to the data to determine how effective vancomycin powder would need to be at reducing a baseline infection rate to make prophylactic use cost effective.

Assuming a 4% baseline infection rate and a cost of vancomycin of $17.15, and the average cost of treating an infection to be $46,745, they found that vancomycin would be cost effective if the initial infection rate decreased by 0.04% (absolute risk reduction, ARR).

Using the current costs of vancomycin reported in the literature (range: $2.50/1000 mg to $44/1000 mg), they determined vancomycin to be cost effective with an ARR range of 0.01% at a cost of $2.50/1000 mg to 0.19% at $44/1000 mg. Baseline infection rate did not influence the ARR obtained at any specific cost of vancomycin or the cost of treating infection.

Comment: While this is an interesting study, we lack data supporting the effectiveness of topical Vancomycin in reducing the rate of Propionibacterium infections in the shoulder. The data to support its use in this article (see below) does not provide this evidence.

A related post of interest shows laboratory evidence in support of topic Vancomycin (see this link).

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