Abstract
This study was set up to evaluate the costs of a one-stage treatment of chronic osteomyelitis using bioactive glass S53P4 versus a two-stage treatment using gentamicin-loaded PMMA beads. Furthermore, a cost-effectiveness analysis was performed from a hospital’s perspective together with the evaluation of clinical outcome. A treatment group (n = 25) receiving one-stage surgery with bioactive glass was retrospectively compared with a two-stage control group (n = 25). An assessment was made of all costs included from first outpatient visit until one year after treatment. Bootstrap simulation and sensitivity analyses were performed. The primary endpoint was cost-effectiveness with clinical outcome as the secondary endpoint. The base case analyses shows dominance of the one-stage treatment with bioactive glass S53P4 due to lower costs and a better clinical outcome. Sensitivity analyses confirm these findings. This study is the first in its kind to show one-stage treatment of chronic osteomyelitis with bioactive glass S53P4 to be cost-effective.
Highlights
Chronic osteomyelitis is still a challenging problem for surgeons and patients [1,2,3]
We evaluate the total cost and cost-effectiveness of treatment of chronic osteomyelitis with the use of bioactive glass S53P4 in a one-stage setting, compared to a group that were treated in a two-stage fashion with intermittent application of antibiotic loaded PMMA beads
Chronic osteomyelitis is a problem with far reaching consequences for the patient and the health system, as morbidity and complications can be numerous and treatment intensive, both from a duration standpoint as well as a cost standpoint
Summary
Chronic osteomyelitis is still a challenging problem for surgeons and patients [1,2,3]. The treatment is time consuming, often involves multiple surgeries and complete eradication is never certain. Treatment has consisted of a two-stage procedure with debridement of infected bone and soft tissues in the first operation. Antibiotics were administered locally as well as parenterally. The local antibiotic spacer could be removed and a reconstruction performed of the bony defect [4,5]. New biomaterials have been introduced that can be used to fill bone defects in the presence of infection. Bioactive glass is such a novel biomaterial. S53P4 Bioactive glass (S53P4 Bonalive® , Bonalive, Turku, Finland) is a synthetic bone graft substitute material consisting of (wt%/mol%)
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