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

• Published in: Injury 2022-10, Vol.53 (10), p.3471-3474
• Main Authors: Steflik, Michael J., Griswold, B. Gage, Patel, Dhara V., Blair, James A., Davis, Jana M.
• Format: Article
• Language: English
• Subjects: Antibiotic coated intramedullary nail; Cost analysis; Economic analysis; Intramedullary nail; Open fracture; Tibia fracture
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2022.08.005

•Antibiotic coated intramedullary nails provide both fracture stability and high concentrations of local antibiotics directly to the open fracture site.•The total cost of treating infection for our institution is approximately $13,283, while the added cost of the antibiotic coated nail is $743.•The use of a prophylactic antibiotic coated nail is cost-effective for GAⅢ fractures if it prevents 1 infection out of 1786 patients.•Infection rates need to be decreased by 0.056% for the antibiotic coated nail to be considered economically viable for GAⅢ fractures. 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. 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 infection 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 associated 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). 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). 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.