Cost-effectiveness of antiseptic impregnated catheters

Clinical bottom line: Antiseptic impregnated central venous catheters save an average of $196 per catheter in healthcare costs in patients at high risk of catheter related bloodstream infections, like those in intensive care.

Central venous catheters are essential in caring for many people in hospital. A problem is bacterial colonisation of the catheter, and occasionally this produces catheter related bloodstream infection in the patient. This is a serious event, incurring high medical costs, and with a substantial of death (10% to 25%). Antiseptic impregnated catheters have been shown to reduce bloodstream infections [1].

Study


DL Veenstra, S Saint, SD Sullivan. Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection. JAMA 1999 282: 554-560.

A decision model was used to evaluate the outcomes associated with using antiseptic impregnated catheters compared to standard catheters for 10,000 hypothetical patients. The population was one at high risk of catheter related infections, like patients in intensive care, immunosuppressed patients, and those receiving parenteral nutrition, and for whom a central venous catheter is required.

The model was populated with information from a meta-analysis of randomised controlled trials [1] and from case-control studies and information of safety from the FDA. Short term use of chlorhexidine-silver sulphadiazine impregnated multilumen catheters over 2-10 days was compared with standard catheters. The direct medical costs were calculated for both types of catheters, together with the expected incidence of catheter related bloodstream infections and death.

Findings


Impregnated catheters reduce the incidence of catheter related bloodstream infections to 3.0% from 5.2% for standard catheters. Impregnated catheters reduce the incidence of death to 0.45% from 0.78% for standard catheters. Impregnated catheters reduce the costs to $336 from $532 for standard catheters (Table). Sensitivity analyses showed impregnated catheters to be superior and cost saving in all eventualities, with the average saving (1998) being $196 (range 68 to 391) per catheter.

  Direct medical costs (US$ 1998) Catheter related bloodstream infections (%) Death from catheter related bloodstream infections of hypersensitivity (%)
Antiseptic impregnated catheter 336 3 0.45
Standard catheter 532 5.2 0.78
Saving from impregnated catheter (range) 196 (68 to 391) 2.2 (1.2 to 3.4) 0.33 (0.09 to 0.78)

Comment


The analysis took into account variations in costs, and the costs of adverse effects from hypersensitivity reactions. It is based on high quality information from a meta-analysis of randomised trials. Although it has a US context, it is likely that savings would occur in any healthcare model.

Reference:

  1. DL Veenstra, S Saint. S Saha, et al. Efficacy of antiseptic impregnated central venous catheters in preventing catheter related bloodstream infection: a meta-analysis. JAMA 1999 281: 261-267.