Taylor Iv Walter L, Bergstein Victoria, Weinblatt Aaron, Long William J
Department of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Arch Orthop Trauma Surg. 2025 Apr 26;145(1):272. doi: 10.1007/s00402-025-05879-9.
Vancomycin is less effective than cefazolin at preventing periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). The purpose of this study was to quantify and compare the costs associated with vancomycin and cefazolin TKA prophylaxis.
We used previously published PJI rates associated with vancomycin and cefazolin prophylaxis to create a model that captured the costs associated with these two options for antibiotic prophylaxis prior to TKA. The model included the cost of the antibiotic used, the cost of staff salaries in both preoperative holding and operating rooms, and the cost of a 2-stage septic TKA revision. National projections were used to account for future TKA volume.
The average per-patient cost associated with cefazolin TKA PJI prophylaxis was $469.79, accounting for a PJI rate of 0.50%. The average per-patient cost associated with vancomycin TKA PJI prophylaxis was $ $1,640.22, accounting for a 1.00% PJI rate. This cost discrepancy could amount to nearly $4.0 billion by 2040 given projections of TKA incidence.
The per-patient cost associated with vancomycin TKA prophylaxis is 250% higher than cefazolin. This difference is due to the increased cost of primary treatment, labor costs associated with prolonged infusion time, and differential PJI rates. In an era of value-based care, cefazolin has been consistently demonstrated as the gold standard for TKA PJI prophylaxis and is associated with significant cost advantages.
在全膝关节置换术（TKA）后预防假体周围关节感染（PJI）方面，万古霉素的效果不如头孢唑林。本研究的目的是量化并比较与万古霉素和头孢唑林用于TKA预防相关的成本。
我们使用先前发表的与万古霉素和头孢唑林预防相关的PJI发生率来创建一个模型，该模型涵盖了TKA术前这两种抗生素预防方案的相关成本。该模型包括所用抗生素的成本、术前等待室和手术室的工作人员薪资成本，以及二期感染性TKA翻修的成本。使用全国预测数据来考虑未来TKA的数量。
与头孢唑林用于TKA预防PJI相关的人均成本为469.79美元，PJI发生率为0.50%。与万古霉素用于TKA预防PJI相关的人均成本为1640.22美元，PJI发生率为1.00%。根据TKA发病率预测，到2040年，这种成本差异可能接近40亿美元。
与万古霉素用于TKA预防相关的人均成本比头孢唑林高250%。这种差异是由于初始治疗成本增加、与延长输注时间相关的劳动力成本以及不同的PJI发生率。在基于价值的医疗时代，头孢唑林一直被证明是TKA预防PJI的金标准，且具有显著的成本优势。
