Cost- utility analysis of dual- antibiotic cement versus single- antibiotic cement for the treatment of displaced intracapsular hip fractures in older adults

AimsTo compare the cost- effectiveness of high- dose, dual-antibiotic cement versus single-antibiotic cement for the treatment of displaced intracapsular hip fractures in older adults.MethodsUsing data from a multicentre randomized controlled trial (World Hip Trauma Evaluation 8 (WHiTE- 8)) in the UK, a within- trial economic evaluation was conducted. Resource usage was measured over 120 days post randomization, and cost-effectiveness was reported in terms of incremental cost per quality-adjusted life year (QALY), gained from the UK NHS and personal social services (PSS) perspective in the base -case analysis. Methodological uncertainty was addressed using sensitivity analysis, while decision uncertainty was han-dled using confidence ellipses and cost-effectiveness acceptability curves.ResultsThe base -case analysis showed that high- dose, dual-antibiotic cement had a significantly higher mean cost (224 pound (95% confidence interval (CI)-408 to 855)) and almost the same QALYs (0.001 (95% CI-0.002 to 0.003)) relative to single-antibiotic cement from the UK NHS and PSS perspective. The probability of the high- dose, dual-antibiotic cement being cost-effective was less than 0.3 at alternative cost-effectiveness thresholds, and its net mone- tary benefit was negative. This finding remained robust in the sensitivity analyses.ConclusionThis study shows that high- dose, dual-antibiotic cement is unlikely to be cost-effective compared to single-antibiotic cement for the treatment of displaced intracapsular hip frac-tures in older adults.