Browsing by Author "Puloski, Shannon"

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    A cost-effectiveness analysis of mupirocin and chlorhexidine gluconate for Staphylococcus aureus decolonization prior to hip and knee arthroplasty in Alberta, Canada compared to standard of care
    (2019-07-11) Rennert-May, Elissa; Conly, John; Smith, Stephanie; Puloski, Shannon; Henderson, Elizabeth; Au, Flora; Manns, Braden
    Abstract Background While decolonization of Staphylococcus aureus reduces surgical site infection (SSI) rates following hip and knee arthroplasty, its cost-effectiveness is uncertain. We sought to examine the cost-effectiveness of a decolonization protocol for Staphylococcus aureus prior to hip and knee replacement in Alberta compared to standard care – no decolonization. Methods Decision analytic models and a probabilistic sensitivity analysis were used for a cost-effectiveness analysis, with the effectiveness of decolonization based on a large published pre- and post- intervention trial. The primary outcomes of the models were infections prevented and health care costs. We modelled the cost-effectiveness of decolonization in a hypothetical cohort of adult patients undergoing hip and knee replacement in Alberta, Canada. Information on the incidence of complex surgical site infections (SSIs), as well as the cost of care for patients with and without SSIs was taken from a provincial infection control database, and health administrative data. Results Use of the decolonization bundle was cost saving compared to usual care ($153/person), and resulted in 16 complex Staphylococcus aureus SSIs annually as opposed to 32 (with approximately 8000 hip or knee arthroplasties performed). The probabilistic sensitivity analysis demonstrated that the majority (84%) of the time the decolonization bundle was cost saving. The model was robust to one-way sensitivity analyses conducted within plausible ranges. There were small upfront costs associated with using a decolonization protocol, however, this model demonstrated cost savings over one year. In a Markov model that considered the impact of a decolonization bundle over a lifetime as it pertained to the need for subsequent joint replacements and patient quality of life, the bundle still resulted in cost savings ($161/person). Conclusions Decolonization for Staphylococcus aureus prior to hip and knee replacements resulted in cost savings and fewer SSIs, and should be considered prior to these procedures.
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    Effectiveness of Immune Checkpoint Inhibitor Therapy on Bone Metastases in Non-Small-Cell Lung Cancer
    (2023-07) Abbott, Annalise Georgia; Monument, Michael; Puloski, Shannon; Cheung, Winson; Morris, Don
    Background: Bone metastases (BoMs) are prevalent in patients with metastatic non-small- cell lung cancer (NSCLC) and frequently result in intractable pain, pathologic fracture, and immobility. Patients who respond to immune checkpoint inhibitors (ICIs) demonstrate meaningful survival improvements, however, there are limited data detailing how BoMs respond. The primary aim of this study was to compare the response of BoMs against visceral lesions in patients treated with ICIs. The secondary aim was to evaluate the effect of BoMs on survival. Methods: A retrospective, multicenter cohort study was conducted in patients with NSCLC treated with ICI in Alberta, Canada from 2015 to 2020. The primary endpoint was the time to progression of bone versus visceral lesions measured with serial imaging studies. Visceral lesions were categorized as adrenal, brain, liver, lung, lymph node, or other intra- abdominal lesions. The secondary outcome was overall survival (OS) amongst patients with and without BoMs. Sub-group analysis was performed in patients with high PD-L1 expression (≥50%). Results: A total of 573 patients were included with a median age of 69.9 years (IQR: 60.6- 73.4) and 268 (46.8%) had high PD-L1 expression. All patients had visceral metastases and 243 patients (42.4%) had BoMs. Median OS for the entire cohort was 8.1 months (95%CI: 6.9-9.1) and median progression free survival (PFS) was 3.8 months (95%CI: 3.1-4.4). No difference was found between the time to progression of bone, liver, and intra-abdominal lesions (p=0.20, p=0.76), but BoMs demonstrated faster progression than the other sites of disease. Subgroup analysis of patients with high PD-L1 expression (≥50%) demonstrated no significant difference in the time to progression between extra-thoracic sites of disease, including BoMs. The presence of BoMs was found to be an independent prognostic factor for OS (HR 1.26, 95%CI: 1.05-1.53, p=0.01) but this was not significant in the high PD-L1 expression subgroup (HR: 1.24, 95%CI: 0.92-1.68, p=0.16). Conclusion: Bone, liver, and intra-abdominal lesions demonstrated a significantly shorter time to progression than other visceral lesions, and patients with BoMs had inferior clinical outcomes. PD-L1 status was identified as an important biomarker predicting response, as patients with high PD-L1 expression demonstrated equivalent responses to ICI amongst extra-thoracic sites of disease.
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    ItemOpen Access