Implant-related infections, including those of peri-prosthetic joint (PJIs), osteosynthesis and other biomaterials, are biofilm-related. Pathogen identification is considered the diagnostic benchmark; however, the presence of bacterial biofilms makes pathogen detection with traditional microbiological techniques only partially effective. To improve microbiological diagnostic accuracy, some biofilm debonding techniques have been recently proposed. Aim of this health economics assessment study was to evaluate their economic impact on hospital costs. Direct and indirect hospital costs connected with the routine introduction of sonication and dithiothreitol treatment applied to hip and knee PJIs and of tissue cultures were examined. In particular the consequences of diagnostic inaccuracy, the opportunities, costs, and risks of each technique were calculated. Considering an average of five samples per patient, processed separately with traditional tissue culture with or without sonication of prosthetic components, or pooled together using the MicroDTTect device (a close system for sample collection, transport and treatment with Dithiothreitol for microbial release from biofilm), the overall mean direct cost per patient was € 397 and € 393 for sonication or MicroDTTect, respectively, compared to € 308 for traditional tissue cultures. In terms of opportunity costs, MicroDTTect was the most effective technique, allowing for a 35% or 55% reduction in time required for sample treatment, compared to tissue cultures combined or not with sonication, respectively. Pooling together direct and indirect costs associated with false positive and negative results of the different diagnostic techniques, unnecessary medical treatments and possible medical claims, MicroDTTect or sonication become increasingly cost-effective when the extra-costs, generated by diagnostic inaccuracy of traditional tissue culture, took place, respectively, in 2% or 20% or more of the patients. This is the first study specifically focused on the economic impact of the routine clinical use of microbiological antibiofilm sampling and processing techniques in orthopaedics. Although our results may suffer from a potential country and hospital bias, as the data collection process for direct and indirect costs is specific to each institution and country, this analysis highlights the potential economic advantage to hospitals associated with the routine introduction of antibiofilm techniques for microbiological diagnosis of PJI.

Purpose: The goal of this study is to understand if ethnocentrism exists at the sub-regional level among honey consumers living in the same production area as a protected designation of origin (PDO). Moreover, this analysis explores if ethnocentrism is influenced by individual economic conditions, among other socio-demographic characteristics.Design/methodology/approach: A sample of 725 consumers was collected through the use of a questionnaire that was circulated in the province of Varese, one of the few honey PDO areas in Italy. The authors performed a principal component analysis and a two-step cluster analysis to identify different PDO honey consumer segments, focusing on their interest for PDO attributes.Findings: The authors identified four consumer segments, depending on socio-demographic, consumption habits, frequencies, preferred attributes and preferences for the PDO product. One cluster exhibited strong preferences for the PDO honey, in the spirit of ethnocentrism, and was characterised by low-income levels; ethnocentric preferences were also observed in another cluster that had a different socio-economic profile.Research limitations/implications: Honey is a niche product and not universally diffused among consumers: further analyses should investigate sub-national ethnocentrism for more universal food products. Yet, through the inspection of the different profiles found, it was possible to devise marketing strategies to boost PDO honey purchasing and to bring consumers closer to PDO products.Originality/value: This analysis considers ethnocentrism as a segmentation criterion for PDO honey consumers that live in the very same PDO honey production area and enriches the existing literature on the relationship between ethnocentrism and individual economic status.