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Figure 1 Overview of Markov model for infected total hip arthroplasty

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Presentation on theme: "Figure 1 Overview of Markov model for infected total hip arthroplasty"— Presentation transcript:

1 Figure 1 Overview of Markov model for infected total hip arthroplasty
Figure 1 Overview of Markov model for infected total hip arthroplasty. The model has 5 general health states. Allowed transitions between health states are indicated by arrows: for example, a patient who underwent temporary resection arthroplasty could either remain in the “temporary resection arthroplasty” health state or transition to the “functional prosthesis” health state by undergoing reimplantation of the prosthetic joint. Death may result from surgery or other competing causes. From: Clinical Effectiveness and Cost-Effectiveness of 2 Management Strategies for Infected Total Hip Arthroplasty in the Elderly Clin Infect Dis. 2001;32(3): doi: /318502 Clin Infect Dis | © 2001 by the Infectious Diseases Society of America

2 Table 1 Variables in the Markov model used to simulate initial management, clinical course, and complications of infected total hip arthroplasty for hypothetical cohorts. From: Clinical Effectiveness and Cost-Effectiveness of 2 Management Strategies for Infected Total Hip Arthroplasty in the Elderly Clin Infect Dis. 2001;32(3): doi: /318502 Clin Infect Dis | © 2001 by the Infectious Diseases Society of America

3 Figure 4 Three-way sensitivity analysis of the annual rate of relapse, age at diagnosis, and acceptable cost-effectiveness threshold for the management strategy of initial debridement and retention. Lines represent incremental cost per quality-adjusted life year (QALY) gained that are necessary to use initial debridement and retention rather than 2-stage exchange arthroplasty ($20,000, $50,000, or $100,000 per QALY). For a given cost-effectiveness threshold, points on or below the line were cost-effective, and points above the line were not cost-effective. Above the uppermost line, debridement and retention cost more but provided less life expectancy than did 2-stage exchange arthroplasty, and therefore dominated. Below the bottom line, debridement and retention was a cost-saving strategy. *Base case. From: Clinical Effectiveness and Cost-Effectiveness of 2 Management Strategies for Infected Total Hip Arthroplasty in the Elderly Clin Infect Dis. 2001;32(3): doi: /318502 Clin Infect Dis | © 2001 by the Infectious Diseases Society of America

4 Figure 3 Sensitivity analysis of age at diagnosis and expected lifetime costs for the non-frail cohorts. When age at initial diagnosis of infected arthroplasty was ⩽79 years, initial debridement and retention was associated with greater total lifetime costs than was 2-stage exchange arthroplasty. When age at initial diagnosis was >79 years, debridement and retention was a cost-saving strategy. From: Clinical Effectiveness and Cost-Effectiveness of 2 Management Strategies for Infected Total Hip Arthroplasty in the Elderly Clin Infect Dis. 2001;32(3): doi: /318502 Clin Infect Dis | © 2001 by the Infectious Diseases Society of America

5 Figure 2 Sensitivity analysis of the annual rate of relapse after debridement and of quality-adjusted life expectancy. Quality-adjusted life expectancy associated with the strategy of initial debridement and retention varied inversely with the annual rate of relapse after debridement. When the rate of relapse decreased to <19% per year, debridement and retention became a cost-saving strategy. When the relapse rate was >61%, debridement and retention cost more but was associated with lower quality-adjusted life expectancy than was 2-stage exchange arthroplasty, and therefore dominated. From: Clinical Effectiveness and Cost-Effectiveness of 2 Management Strategies for Infected Total Hip Arthroplasty in the Elderly Clin Infect Dis. 2001;32(3): doi: /318502 Clin Infect Dis | © 2001 by the Infectious Diseases Society of America

6 Table 4 Selected univariate sensitivity analyses for a base case of infected total hip arthroplasty in a hypothetical 65-year-old male patient. From: Clinical Effectiveness and Cost-Effectiveness of 2 Management Strategies for Infected Total Hip Arthroplasty in the Elderly Clin Infect Dis. 2001;32(3): doi: /318502 Clin Infect Dis | © 2001 by the Infectious Diseases Society of America

7 Table 3 Outcomes associated with debridement and 2-stage exchange arthroplasty for 4 hypothetical cohorts. From: Clinical Effectiveness and Cost-Effectiveness of 2 Management Strategies for Infected Total Hip Arthroplasty in the Elderly Clin Infect Dis. 2001;32(3): doi: /318502 Clin Infect Dis | © 2001 by the Infectious Diseases Society of America

8 Table 2 Clinical outcomes associated with debridement and 2-stage exchange arthroplasty for 4 hypothetical cohorts. From: Clinical Effectiveness and Cost-Effectiveness of 2 Management Strategies for Infected Total Hip Arthroplasty in the Elderly Clin Infect Dis. 2001;32(3): doi: /318502 Clin Infect Dis | © 2001 by the Infectious Diseases Society of America

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