Two-stage exchange arthroplasty remains the gold standard for the management of prosthetic joint infection (PJI) of the knee, but several studies have demonstrated that 1-stage exchange is as effective as 2-stage exchange. This study aimed to support decision-making via an economic evaluation of 1-stage compared to 2-stage exchange for total knee arthroplasty septic revision in patients who did not have compelling indication PJI (ie, Methicillin-resistant , multiorganism, systemic sepsis, comorbidities, culture negative, resistant organism, and immunocompromised) to undergo a 2-stage exchange. A cost-utility analysis was performed using a Markov cohort model from the health care provider perspective using Australia data. One-stage septic knee revisions were compared with 2-stage exchange procedures for chronic PJI using a patient-lifetime horizon. Health outcomes were expressed as quality-adjusted life-years (QALY), whereas costs were presented in 2020 Australian dollars. Sensitivity analyses, population expected values of perfect information, and the perfect information for parameters (EVPPI) were assessed to estimate the opportunity costs surrounding the decision made at a willingness-to-pay threshold of $50,000 per QALY. The incremental cost-effectiveness ratio of 2-stage exchange compared with 1-stage exchange was $231,000 per QALY, with 98.5% of the probabilistic sensitivity simulations above the willingness-to-pay threshold. The population expected value of perfect information was $882,000, whereas the expected value of perfect information for parameters for the “cost parameters” was $207,000. The adoption of 1-stage septic knee revision is the optimal choice for patients who have a PJI and who do not have a compelling need for a 2-stage exchange arthroplasty. One-stage exchange for PJI should be advocated in patients who meet the eligibility criteria.

中文翻译：

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两阶段化粪池改造值得花钱吗？全膝关节置换术一期与二期脓毒症翻修的成本效用分析

两阶段置换术仍然是治疗膝关节假体关节感染 (PJI) 的金标准，但多项研究表明 1 阶段置换术与 2 阶段置换术一样有效。本研究旨在通过对全膝关节置换术脓毒症翻修的 1 阶段与 2 阶段交换进行经济评估来支持决策，这些患者没有令人信服的 PJI 指征（即耐甲氧西林、多微生物、全身性脓毒症、合并症） 、培养阴性、耐药微生物和免疫功能低下）进行两阶段交换。使用澳大利亚数据从医疗保健提供者的角度使用马尔可夫队列模型进行成本效用分析。使用患者终生视野，对慢性 PJI 的一阶段脓毒症膝关节翻修术与两阶段交换手术进行比较。健康结果以质量调整生命年 (QALY) 表示，而成本以 2020 年澳元表示。通过敏感性分析、完美信息的总体预期值以及参数的完美信息 (EVPPI) 进行评估，以估计围绕每个 QALY 50,000 美元的支付意愿门槛做出的决策的机会成本。与 1 阶段交换相比，2 阶段交换的增量成本效益比为每 QALY 231,000 美元，98.5% 的概率敏感性模拟高于支付意愿阈值。完美信息的总体预期值为 882,000 美元，而“成本参数”参数的完美信息预期值为 207,000 美元。对于患有 PJI 并且不迫切需要进行 2 阶段交换关节置换术的患者来说，采用 1 阶段脓毒症膝关节翻修术是最佳选择。对于符合资格标准的患者，应提倡一期置换 PJI。