These authors conducted a study using break-even models to estimate the economic viability of benzoyl peroxide and hydrogen peroxide for infection prevention in shoulder arthroplasty. This approach is used in settings with low outcome event rates that would realistically preclude a randomized clinical trial. ·
Skin preparation costs ($11.76 for benzoyl peroxide; $0.96 for hydrogen peroxide), baseline infection rates for shoulder arthroplasty (0.70%), and infection-related care costs ($50,230) were derived from institutional records and the literature. A break-even equation incorporating these variables was developed to determine the absolute risk reduction (ARR) in infection rate to make prophylactic use economically justified. The number needed to treat was calculated from the ARR.
This analysis found that topical benzoyl peroxide is considered economically justified if it prevents at least 1 infection out of 4,348 shoulder arthroplasties (ARR=0.023%). Hydrogen peroxide is economically justified if it prevents at least 1 infection out of 50,000 cases (ARR=0.002%).
The authors caution that efforts to determine drawbacks of routine skin decolonization strategies are warranted as they may change the value analysis.
This analysis found that topical benzoyl peroxide is considered economically justified if it prevents at least 1 infection out of 4,348 shoulder arthroplasties (ARR=0.023%). Hydrogen peroxide is economically justified if it prevents at least 1 infection out of 50,000 cases (ARR=0.002%).
The authors caution that efforts to determine drawbacks of routine skin decolonization strategies are warranted as they may change the value analysis.
Comment: This is an interesting study. Two challenges surface, however. First, published studies show that these two agents reduce but do not eliminate Cutibacterium from or "decolonize" the skin. It will be interesting to see the degree to which reduction of the skin Cutibacterium load leads to a measurable reduction in the infection rate. Second, while, on the surface, the rate of Cutibacterium periprosthetic infections seems to be a good endpoint, the criteria for making this diagnosis are still in discussion (see this link) and it is recognized that a long time can pass between the index surgery and the diagnosis of a Cutibacterium periprosthetic infection at the time of surgical revision (see this link).
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