Lane Pearce W, Griswold B Gage, Paré Daniel W, Bushnell Brandon D, Parada Stephen A
Medical College of Georgia, Augusta University, Augusta, Georgia, U.S.A.
Department of Orthopaedics, Augusta University Medical Center, Augusta, Georgia, U.S.A.
Arthrosc Sports Med Rehabil. 2021 May 15;3(4):e1119-e1123. doi: 10.1016/j.asmr.2021.03.021. eCollection 2021 Aug.
To evaluate the cost-effectiveness of benzoyl peroxide (BPO) in decreasing postoperative infections through a mathematical model in the setting of arthroscopic rotator cuff repair (RCR).
A break-even equation compared the costs associated with perioperative BPO use and postoperative infection following an arthroscopic RCR. The postoperative infection rate used for calculations was 0.28%, a value established in current literature. The break-even analysis produced a new infection rate, which defined how much BPO is needed to reduce the known infection rate in order for its prophylactic use to be cost-effective. The institution's business office assessed the minimum itemized costs associated with the standard-of-care treatment of postoperative RCR infection. Sensitivity analysis was conducted to demonstrate how variability in the costs of BPO, in infection rates and in the cost of infection treatment affected the absolute risk reduction (ARR) and number needed to treat (NNT).
Financial review yielded a minimum institutional cost of treating a postoperative infection following arthroscopic RCR of $24,991.31. Using the break-even formula to calculate the ARR at which the overhead costs of BPO and the treatment of infection were equal, BPO was economically viable if it decreased infection rate by 0.000734% (NNT = 1,361.92). This value was low because of the order of magnitude of difference between the costs of infection prevention when compared to the costs of treating postoperative infections.
This break-even analysis model suggests that the use of preoperative BPO in the setting of arthroscopic RCR is cost-effective for prevention of infection with , given the high cost of treating the infection versus the low cost of the solution.
The economic feasibility of preoperative use of BPO in the setting of arthroscopic RCR could alter the standard of care.
通过数学模型评估在关节镜下肩袖修复术（RCR）中使用过氧化苯甲酰（BPO）降低术后感染的成本效益。
采用盈亏平衡方程比较关节镜下RCR围手术期使用BPO与术后感染的相关成本。计算中使用的术后感染率为0.28%，这是当前文献中确定的值。盈亏平衡分析得出了一个新的感染率，该感染率定义了为使预防性使用BPO具有成本效益，需要降低多少已知感染率。该机构的商务办公室评估了与术后RCR感染标准治疗相关的最低分项成本。进行敏感性分析以证明BPO成本、感染率和感染治疗成本的变化如何影响绝对风险降低率（ARR）和治疗所需人数（NNT）。
财务审查得出关节镜下RCR术后感染的最低机构治疗成本为24,991.31美元。使用盈亏平衡公式计算BPO的间接成本与感染治疗成本相等时的ARR，若BPO能将感染率降低0.000734%（NNT = 1,361.92），则其在经济上是可行的。由于与术后感染治疗成本相比，感染预防成本的差异量级，该值较低。
这种盈亏平衡分析模型表明，鉴于感染治疗成本高而解决方案成本低，在关节镜下RCR中术前使用BPO预防感染具有成本效益。
关节镜下RCR术前使用BPO的经济可行性可能会改变治疗标准。
