The use of antibiotic bone cement has caught the attention of both supply chain organizations in hospitals as well as clinicians: from a supply chain perspective the additional cost (about three times the cost of regular bone cement) makes it a target for monitoring and negotiation; from a clinical perspective, anything that helps prevent joint infections would be welcome. Clinically there are questions of the efficacy of antibiotic bone cement, and whether its overuse will lead to superbugs.

What hasn’t been reported on are the difference in utilization and price of antibiotic bone cement from non-US sources. Since the FDA has allowed manufacturers to submit non-US data to support their applications for device clearances and approvals, it only makes sense to consider non-US sources for pricing differences.

Orthopedic Network News (ONN) was able to contact sources to compare prices of regular and antibiotic bone cement in England, France, Australia, and New Zealand. Although each of these countries do not perform as many joint replacements as is performed in the US, they all boast national pricing schedules and joint registries that allow tracking of outcomes. Annual joint replacement procedures in England were reported to be about 225,000, and about 118,000 in Australia, compared to about 1.7 million in the US.

Utilization of Antibiotic Bone Cement in Total Knee Replacements

Although all of these countries have lower prices for most medical devices than the US, the interesting aspect is the ratio of prices of antibiotic bone cement to regular bone cement. In the US, the price of antibiotic bone cement is 3.2 times higher than the price of regular bone cement. However, the price in other countries was only 1.1 to 1.3 times higher. In the US, that would put the cost of antibiotic bone cement at a cost of only $61 to $71, which could save about $100/case for the cases using antibiotic bone cement.

The vast majority of joint replacements in the National Joint Registry of England, North Ireland, and Wales (NJR) was reported to have used antibiotic bone cement (98%) for knee replacements, and the Australian joint registry reported 99% of their bone cement as antibiotic compared to 47% in the US. Because of the large price difference in the US, many physicians and facilities have begun to compound their own antibiotic bone cement by mixing regular bone cement with a small amount of antibiotic, so the actual utilization of antibiotic bone cement is likely much higher than that reported here. At least one paper from the National Joint Registry reports lower revision rates for cases with antibiotic bone cement.

One would assume that a bone cement with antibiotic mixed in by a bone cement provider would be more uniform in quality than one compounded by a hospital.

“The case before us involves another skirmish in a long- running, cross-border court battle over the alleged theft of a trade secret: Heraeus Medical GmbH’s recipe for its bone cement.”

Opinion of the Court
Heraeus v. Esschem, Inc., number 18-1368 Opinion filed: June 21, 2019

However, two of the largest manufacturers of bone cement, Heraeus and Zimmer Biomet, have been entangled in decades-long litigation. It would be interesting to speculate on the cost of that litigation compared to the revenue they may lose by adopting a pricing policy in the US more similar to the European one. That may, incidentally, result in improved patient outcomes, a goal ostensibly of all of the parties.

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History of Palacos Bone Cement