Cost-utility analysis of dual-antibiotic cement versus single-antibiotic cement for the treatment of displaced intracapsular hip fractures in older adults: the WHiTE-8 trial

Journal article

Aims: To 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.

Methods: Using 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 handled using confidence ellipses and cost-effectiveness acceptability curves.

Results: The base-case analysis showed that high-dose, dual-antibiotic cement had a significantly higher mean cost (£224 (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 monetary benefit was negative. This finding remained robust in the sensitivity analyses.

Conclusion: This 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 fractures in older adults.

Authors: Png, ME; Costa, ML; Agni, NR; Achten, J; Peckham, N

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: British Editorial Society of Bone and Joint Surgery
• Journal: Bone and Joint Journal
• Volume: 105-B
• Issue: 10
• Pages: 1070-1077
• Publication date: 2023-10-01
• Acceptance date: 2023-07-18
• DOI: 10.1302/0301-620X.105B10.BJJ-2023-0633
• EISSN: 2049-4408
• ISSN: 2049-4394
• Language: English
• Keywords: antibiotics; cost; displaced intracapsular hip fractures; t-tests; hip; hip fractures; hemiarthroplasty; FFR; cemented hemiarthroplasty; effectiveness; cement; sensitivity analysis; trauma; multicentre randomized controlled trial