OBJECTIVES: Bone and deep wound infections are associated with increased length of stay and higher costs in patients with open tibial fractures. Infection risks increase with implant usage and open fracture severity. Innovations to reduce risks include antibacterial coated implants. This study models whether use of antibiotic coated implants in patients at high-risk of infection is cost-effective.

METHODS: An economic model compared infection rates and costs associated with surgery and hospital stay in patients with a Gustilo-Anderson (GA) classification open fractures, for two patient cohorts. All GAIII patients in the first cohort received an antibiotic coated tibial nail (ETN PROtect^®) whilst the remaining GAI and GAII patients in the same cohort received a standard nail. GAIII patients received the antibiotic coated nail due to their higher infection risk. The second cohort all received a standard tibial nail. Four European trauma centres provided patient-level data on inpatient days, theatre use and related costs for patients with and without infections. Absolute infection risks and relative risk reductions, for antibiotic coated nails compared to standard nails were obtained from a meta-analysis.

RESULTS: Using the antibiotic coated implant in patients at high-risk of infection (GAIII) was cost saving; the higher cost of the implant was offset by fewer infections, reduced inpatient days and fewer re-operations. Scenario analysis demonstrated using a coated nail in all open fracture patients was cost effective in 3 out of 4 centres.

CONCLUSIONS: The analyses demonstrated that hospitals could reduce costs by 4-13% by adopting the antibiotic coated nail in patients at high-risk of infection. Infection reduction releases beds and reduces re-operations. Results are sensitive to underlying infection risks; therefore patient selection is important to ensure a cost-effective outcome. Further research is required to improve the identification of high-risk patients most likely to benefit from antibiotic coated implants.