Cost-effectiveness of oral versus intravenous antibiotics (OVIVA) in patients with bone and joint infection: evidence from a non-inferiority trial

McMeekin, N., Geue, C. , Briggs, A. , Rombach, I., Li, H. K., Bejon, P., McNally, M., Atkins, B. L., Ferguson, J. and Scarborough, M. (2020) Cost-effectiveness of oral versus intravenous antibiotics (OVIVA) in patients with bone and joint infection: evidence from a non-inferiority trial. Wellcome Open Research, 4, 108. (doi: 10.12688/wellcomeopenres.15314.4)

Abstract

Background: Bone and joint infections are becoming increasingly common and are usually treated with surgery and a course of intravenous antibiotics. However, there is no evidence to support the superiority of intravenous therapy and there is a growing body of literature showing that oral therapy is effective in treating these infections.Given this lack of evidence the clinical trial ‘Oral Versus Intravenous Antibiotics’ (OVIVA) was designed to assess the clinical and cost-effectiveness of intravenous versus oral antibiotics for the treatment of bone and joint infections, using a non-inferiority design. Clinical results from the trial indicate that oral antibiotics are non-inferior to intravenous antibiotics. The aim of this paper is to evaluate the cost-effectiveness of intravenous compared to oral antibiotics for treating bone and joint infections, using data from OVIVA. Methods: A cost-utility analysis was carried out, the main economic outcome measure was the quality adjusted life-year, measured using the EQ-5D-3L questionnaire, combined with costs to estimate cost-effectiveness over 12-months follow-up. Results: Results show that costs were significantly lower in the oral arm compared to the intravenous arm, a difference of £2,740 (95% confidence interval £1,488 to £3,992). Results of four sensitivity analyses were consistent with the base-case results. QALYs were marginally higher in the oral arm, however this difference was not statistically significant; -0.007 (95% confidence interval -0.045 to 0.031). Conclusions: Treating patients with bone and joint infections for the first six weeks of therapy with oral antibiotics is both less costly and does not result in detectable differences in quality of life compared to treatment with intravenous antibiotics. Adopting a practice of treating bone and joint infections with oral antibiotics early in the course of therapy could potentially save the UK National Health Service over £17 million annually.

• Item Type: Articles
• Additional Information: Version 4; peer review: 2 approved.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mcmeekin, Dr Nicola and Geue, Dr Claudia and Briggs, Professor Andrew

Creator Roles

McMeekin, N.: Conceptualization, Formal analysis, Methodology, Writing – original draft
Geue, C.: Conceptualization, Formal analysis, Methodology, Writing – original draft
Briggs, A.: Conceptualization, Funding acquisition, Methodology, Writing – review and editing

• Authors: McMeekin, N., Geue, C., Briggs, A., Rombach, I., Li, H. K., Bejon, P., McNally, M., Atkins, B. L., Ferguson, J., and Scarborough, M.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
• Journal Name: Wellcome Open Research
• Publisher: F1000Research
• ISSN: 2398-502X
• ISSN (Online): 2398-502X
• Published Online: 17 July 2019
• Copyright Holders: Copyright © 2019 McMeekin et al.
• First Published: First published in Wellcome Open Research 4: 108
• Publisher Policy: Reproduced under a Creative Commons License