A Decision Support Framework for Periprosthetic Joint Infection Treatment: A Cost-Effectiveness Analysis Using Two...

Area of Science:

• Orthopedic surgery
• Health economics
• Medical decision making

Background:

• Periprosthetic joint infection (PJI) is a major complication of artificial joint surgery, often necessitating revision procedures.
• Effective treatment planning for PJI requires robust cost-effectiveness assessments to guide clinical and economic decisions.
• Current methods lack comprehensive frameworks for comparing diverse PJI treatment strategies.

Purpose of the Study:

• To develop and apply a composite decision support modeling framework for assessing the cost-effectiveness of periprosthetic joint infection (PJI) treatment strategies.
• To compare different PJI treatment methods based on associated costs and quality-adjusted life years (QALYs) gained.
• To provide ranked insights into the most cost-effective PJI interventions.

Main Methods:

• A composite decision support modeling framework was developed, integrating a discrete-event probabilistic model (decision tree) and a dynamic Markov model.
• The framework was applied to a dataset of 600 patient records from the Russian Scientific Research Institute of Traumatology and Orthopedics.
• Cost-effectiveness was evaluated by calculating costs and QALYs for various PJI treatment strategies using both implemented models.

Main Results:

• Two distinct comparative rankings of PJI treatment methods were generated based on the outputs of the discrete-event and Markov models.
• The study successfully demonstrated the application of the decision support framework in evaluating real-world patient data.
• The models provided independent yet complementary assessments of cost-effectiveness for different PJI interventions.

Conclusions:

• The developed composite decision support framework offers a valuable tool for planning and selecting optimal treatment strategies for periprosthetic joint infection (PJI).
• Cost-effectiveness analysis, incorporating QALYs, is crucial for guiding resource allocation in managing PJI.
• The study provides evidence-based rankings to aid clinicians and policymakers in choosing the most effective and economical PJI treatments.