Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, United States.
Medical College of Georgia at Augusta University, 1120 15th Street, Augusta, GA 30912, United States.
Injury. 2022 Oct;53(10):3471-3474. doi: 10.1016/j.injury.2022.08.005. Epub 2022 Aug 4.
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.
评估抗生素涂层髓内钉（IMN）在 Gustilo-Anderson Ⅲ型（GAIII）开放性胫骨骨折初始治疗中的成本效益。
使用盈亏平衡方程分析与 GAIII 开放性胫骨骨折后抗生素涂层 IMN 和术后感染相关的成本。该方程产生了一个新的感染率，该感染率定义了抗生素涂层 IMN 需要降低初始感染率的百分比，以使其预防性使用具有成本效益。计算中使用的术后感染率为 30%，这是当前文献中这些骨折类型（6-33%）确定的值。确定了与单次手术清创以及由此导致的住院和治疗相关的机构成本。进行了敏感性分析，以展示各种感染总成本和不同感染率如何影响盈亏平衡率、绝对风险降低（ARR）和需要治疗的数量（NNT）。
财务审查得出的治疗术后感染的平均机构成本为 13282.85 美元。这个数字包括住院期间的所有程序。抗生素涂层植入物给医院带来的额外成本为 743.42 美元。利用这些成本和 30%的初始感染率的盈亏平衡公式，如果抗生素涂层 IMN 将感染率降低 0.056%（NNT=1785714），则其在经济上是可行的。
该盈亏平衡分析模型表明，在 GAIII 开放性胫骨骨折的情况下，初始使用抗生素涂层 IMN 具有成本效益。
