A Decision Support Framework for Periprosthetic Joint Infection Treatment: A Cost-Effectiveness Analysis Using Two Modeling Approaches.

Today, periprosthetic joint infection (PJI) is one of the leading indications for revision surgery and the most ominous complication in artificial joint patients. The current state of the art for treating PJI requires the development of methods for planning the costs at different scales to facilitate the selection of the best treatment methods. In this paper, we perform a cost-effectiveness assessment for strategies related to the treatment of PJI using a composite decision support modeling framework. Within the framework, two models are implemented: a detailed discrete-event probabilistic model based on the decision tree approach and a dynamic Markov model with generalized states. The application of the framework is demonstrated on the dataset which was provided by the Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden. The analyzed dataset contains 600 patient records divided into two groups (retrospective group, based on old records, and prospective group, based on real-time follow-up). The cost-effectiveness of treatment methods was compared based on associated costs and QALY units gained, with the mentioned two indicators calculated using two models independently from each other. As a result, two comparative rankings of cost-effectiveness of PJI treatment methods were presented based on the model output.