Original ContributionsAntibiotic ProphylaxisCost-effectiveness of antibiotic prophylaxis for dental patients with prosthetic joints: Comparisons of antibiotic regimens for patients with total hip arthroplasty
Section snippets
Model design
We used cost-effectiveness decision modeling to evaluate antibiotic prophylaxis strategies for preventing PJI after dental visits.13 We compared expenditures and costs and related health outcomes (associated with PJIs) for alternative antibiotic prophylaxis strategies. We developed a Markov decision model to project lifetime harms, benefits, and economic outcomes for a hypothetical cohort of 65-year-old patients who had undergone THA. We studied alternative routine antibiotic prophylaxis
Results
The analysis showed that the no-antibiotic prophylaxis strategy was the least costly and most effective for dental patients aged 65 years with a prosthetic hip replacement. Foregoing antibiotic prophylaxis before dental visits, consistent with the first recommendation of the 2012 AAOS/ADA guideline11 and the 2015 ADA guideline,12 was the most cost-effective strategy, as it resulted in lower accumulated costs ($11,909) and higher accumulated QALYs (12.3745) than the alternative prophylaxis
Discussion
Antibiotic prophylaxis before dental procedures for patients with total joint prostheses remains controversial.5, 37 Compelling evidence that prophylaxis reduces dental patients’ risk of experiencing PJI is lacking. Routine prophylaxis may confer adverse clinical risks and associated costs. In our study, which compared dental prophylaxis strategies using lifetime cost-effectiveness modeling, we attempted to inform this discussion by including these issues. The results of our cost-effectiveness
Conclusions
It is indisputable that PJI is a serious, potentially debilitating, and costly complication that can occur after total joint arthroplasty, and that it is of great concern to clinicians. The tendency of orthopedists and dentists to prescribe prophylactic antibiotics to patients before they undergo invasive dental procedures is understandable. The incidence of bacteremia after dental procedures is well documented; however, the incidence of bacteremia developing as a result of common activities of
Dr. Skaar is an associate professor, Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, 7-368 Moos Tower, Minneapolis, MN 55455.
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Dr. Skaar is an associate professor, Division of Periodontology, Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, 7-368 Moos Tower, Minneapolis, MN 55455.
Dr. Park is an assistant professor, Department of Pharmaceutical and Administrative Sciences, St. Louis College of Pharmacy, St. Louis, MO.
Dr. Swiontkowski is a professor, Department of Orthopaedic Surgery, Medical School, and an adjunct professor, School of Public Health, University of Minnesota, Minneapolis, MN.
Dr. Kuntz is a professor, Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN.
Disclosure. None of the authors reported any disclosures.