Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2019; 7(14): 1825-1836
Published online Jul 26, 2019. doi: 10.12998/wjcc.v7.i14.1825
Cost-analysis of inpatient and outpatient parenteral antimicrobial therapy in orthopaedics: A systematic literature review
Christoph Kolja Boese, Philipp Lechler, Michael Frink, Michael Hackl, Peer Eysel, Christian Ries
Christoph Kolja Boese, Michael Hackl, Peer Eysel, Christian Ries, Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Cologne 50931, Germany
Philipp Lechler, Clinic for Trauma and Hand Surgery, Kreiskliniken, Altötting 84503, Germany
Philipp Lechler, Michael Frink, Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg 35043, Germany
Author contributions: Boese CK designed the study and performed the literature analysis; Boese CK analysed the data and Ries C reviewed the data analysis critically; Boese CK and Ries C wrote substantial parts of the manuscript; Lechler P and Frink M provided input to the study concept; Lechler P, Frink M, Hackl M and Eysel P critically reviewed the manuscript and provided expert opinion.
Conflict-of-interest statement: Boese CK is employee of Smith and Nephew GmbH, Germany. The other authors report no conflict of interest. All authors have no financial disclosures with respect to this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Christoph Kolja Boese, MD, Senior Lecturer, Department of Orthopaedic and Trauma Surgery, University Hospital of Cologne, Joseph-Stelzmann Street 9, Cologne 50931, Germany. christoph.boese@uk-koeln.de
Telephone: +49-221-4784682 Fax: +49-221-47886731
Received: March 8, 2019
Peer-review started: March 11, 2019
First decision: May 10, 2019
Revised: May 28, 2019
Accepted: June 27, 2019
Article in press: June 27, 2019
Published online: July 26, 2019
Processing time: 141 Days and 0.8 Hours
Abstract
BACKGROUND

Increasing numbers of total joint arthroplasties and consecutive revision surgery are associated with the risk of periprosthetic joint infections (PPJI). Treatment of PPJI is complex and associated with immense socio-economic burden. One treatment aspect is parenteral antiinfective therapy, which usually requires an inpatient setting [Inpatient parenteral antibiotic therapy (IPAT)]. An alternative is outpatient parenteral treatment [Outpatient parenteral antibiotic therapy (OPAT)]. To conduct a health economic cost-benefit analysis of OPAT, a detailed cost analysis of IPAT and OPAT is required. So far, there is a lack of knowledge on the health economic effects of IPAT and OPAT for PPJI.

AIM

To review an economic comparison of IPAT and OPAT.

METHODS

A systematic literature review was performed through Medline following the PRISMA guidelines.

RESULTS

Of 619 identified studies, 174 included information of interest and 21 studies were included for quantitative analysis of OPAT and IPAT costs. Except for one study, all showed relevant cost savings for OPAT compared to IPAT. Costs for IPAT were between 1.10 to 17.34 times higher than those for OPAT.

CONCLUSION

There are only few reports on OPAT for PPJI. Detailed analyses to support economic or clinical guidelines are therefore limited. There is good clinical evidence supporting economic benefits of OPAT, but more high quality studies are needed for PPJI.

Keywords: Antibiotic therapy; Outpatient parenteral antibiotic therapy; Inpatient parenteral antibiotic therapy; Cost analysis; Periprosthetic joint infection; Parenteral

Core tip: Periprosthetic joint infection of total joint replacement poses a significant socio-economic burden. One factor is the need for prolonged parenteral antibiotic therapy. Outpatient parenteral antibiotic therapy (OPAT) might reduce costs compared to inpatient (IPAT) settings. A systematic literature review was performed to compare economic impact of OPAT and IPAT. Twenty-one articles were identified of which 20 reported economic benefits of OPAT. While the heterogeneity of studies limited the interpretation and generalization, overall beneficial cost effects of OPAT were shown. Future studies should focus on specific economic outcomes of OPAT for PPJI.