Cost-Effectiveness of Staphylococcus aureus Decolonization Strategies in High-Risk Total Joint Arthroplasty Patients

Devin M. Williams, Andy O. Miller*, Michael W. Henry, Geoffrey H. Westrich, Hassan M K Ghomrawi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background The risk of prosthetic joint infection increases with Staphylococcus aureus colonization. The cost-effectiveness of decolonization is controversial. We evaluated cost-effectiveness decolonization protocols in high-risk arthroplasty patients. Methods An analytical model evaluated risk under 3 protocols: 4 swabs, 2 swabs, and nasal swab alone. These were compared to no-screening and universal decolonization strategies. Cost-effectiveness was evaluated from the hospital, patient, and societal perspective. Results Under base case conditions, universal decolonization and 4-swab strategies were most effective. The 2-swab and universal decolonization strategy were most cost-effective from patient and societal perspectives. From the hospital perspective, universal decolonization was the dominant strategy (much less costly and more effective). Conclusion S aureus decolonization may be cost-effective for reducing prosthetic joint infections in high-risk patients. These results may have important implications for treatment of patients and for cost containment in a bundled payment system.

Original languageEnglish (US)
Pages (from-to)S91-S96
JournalJournal of Arthroplasty
Issue number9
StatePublished - Sep 2017


  • Staphylococcus aureus
  • arthroplasty
  • cost-effectiveness
  • decolonization
  • prosthetic joint infection
  • surgical site infection

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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