Antibiotic cement-coated intramedullary nail is cost-effective for the initial treatment of GA III open tibia fractures

Objective: To evaluate the cost-effectiveness of antibiotic cement-coated intramedullary nails (IMN) in the initial management of Gustilo-Anderson type III (GAIII) open tibia fractures. Methods: A break-even equation was used to analyze the costs associated with antibiotic cement-coated IMN and postoperative infection following GAIII open tibia fractures. This equation produced a new infec-tion rate, which defines what percentage the antibiotic coated IMN needs to decrease the initial infection rate for its prophylactic use to be cost-effective. The postoperative infection rate used for calculations was 30%, a value established in current literature for these fracture types (6-33%). The institutional costs asso-ciated with a single operative debridement and resultant inpatient stay and treatment were determined. A sensitivity analysis was conducted to demonstrate how various total costs of infection and different infection rates affected the break-even rate, the absolute risk reduction (ARR), and the number needed to treat (NNT). Results: Financial review yielded an average institutional cost of treating a postoperative infection to be $13,282.85. This number was inclusive of all procedures during an inpatient stay. The added cost of the antibiotic coated implant to the hospital is $743.42. Utilizing the break-even formula with these costs and a 30% initial infection rate, antibiotic coated IMN was economically viable if it decreased infection rate by 0.056% (NNT = 1,785.714). Conclusion: This break-even analysis model suggests the initial use of an antibiotic coated IMN in the setting of GAIII open tibia fractures is cost-effective. (c) 2022 Elsevier Ltd. All rights reserved.

Automated summary

This study evaluates the cost-effectiveness of antibiotic cement-coated intramedullary nails in the initial management of GAIII open tibia fractures. The break-even analysis suggests that the use of antibiotic-coated IMN is cost-effective in reducing infection rates.