The financial burden of vancomycin as an alternative to cefazolin for periprosthetic joint infection prophylaxis in total knee arthroplasty.

INTRODUCTION

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.

MATERIALS AND METHODS

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.

RESULTS

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.

CONCLUSION

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.