OBJECTIVES

: Periprosthetic joint infection (PJI) is one of the most devastating and costly complications following total joint arthroplasty. Current standard diagnostic tests, individually, may not be accurate enough to confidently differentiate between aseptic and septic failures. Human alpha-defensin is an antimicrobial peptide released in response to infection. An alfa-defensin point of care test, used in conjunction with other clinical and diagnostic findings to aid in the diagnosis of PJI, has the potential to improve accuracy, inform better treatment options and save money . This research uniquely sought to determine the budget impact implications to NHSScotland of including the alfa-defensin test for PJI during revision Total Hip Arthroplasty (rTHA) and revision Total Knee Arthroplasty (rTKA), driven by combined superior sensitivity and specificity compared with standard diagnostic methods alone.

METHODS

: A budget impact model was designed to identify the associated cost offsets achieved via the improved sensitivity and specificity achieved by including alfa-defensin testing compared to current standard PJI diagnostics alone. The model reflected direct cost savings attributable to more precise diagnosis of PJI and the associated improvement of patient care.

RESULTS

: The model demonstrates that if alfa-defensin testing were included in the assessment of every annual Scottish rTHA and rTKA (n=1300) , the potential annual cost-savings to NHSScotland is 1.82M GBP. Furthermore, there is the potential yield other benefits which have not been factored in the net savings estimate. For example, reducing the misidentification of PJI cases can potentially free up important healthcare resources (e.g. operating theatre time, bed days) and their associated opportunity cost. Healthcare Improvement Scotland has published an Innovative Medical Technology Overview (IMTO) assessment of the Alpha-Defensin test

CONCLUSIONS

: The improved accuracy of adding the alfa-defensin test to standard PJI diagnostic methods for patients undergoing rTKA or rTHA has the potential for improved patient treatment pathways and significant cost savings to NHSScotland.