Silver-impregnated occlusive dressings are a cost-effective strategy for preventing infection after total shoulder arthroplasty

Abstract

PurposeThe purpose of this study was to determine the cost-effectiveness of the most commonly used type of antimicrobial silver-impregnated occlusive dressing (Aquacel Ag, ConvaTec, Oklahoma City, OK, USA) for prosthetic shoulder infection (PSI) prevention after shoulder arthroplasty. MethodsData regarding the cost of silver-impregnated occlusive dressing, cost to treat a PSI and initial infection rates after shoulder arthroplasty were calculated from available literature. Using a break-even economic analysis, we developed an equation that incorporated these variables to determine the absolute risk reduction (ARR) in infection rate required to make the use of this dressing cost-effective. To provide a widely applicable and reusable model, multiple simulations were performed at varying unit costs, infection rates, and PSI-related care costs. ResultsAt a dressing cost of $34.00 and presuming a cost of $50,230 for treating a PSI, these dressings are considered cost-effective if their use prevents at least 1 infection in 1471 TSA (ARR of 0.068% from the initial infection rate of 0.7%). The cost-effectiveness of this dressing was maintained through a realistic range of dressing and PSI treatment costs, while initial infection rate was found not to influence cost-effectiveness. ConclusionsAntimicrobial silver-impregnated occlusive dressings represent a cost-effective infection prevention strategy after shoulder arthroplasty. The presented model serves as a useful resource to aid in weighing the economic effects of implementing any potential prophylactic measures aimed at minimizing infections after shoulder arthroplasty. Level of EvidenceLevel IV; Economic Decision Analysis