Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection.
BACKGROUND
A recent randomized controlled trial and meta-analysis indicated that central venous catheters impregnated with an antiseptic combination of chlorhexidine and silver sulfadiazine are efficacious in reducing the incidence of catheter-related bloodstream infection (CR-BSI); however, the ultimate clinical and economic consequences of their use have not been formally evaluated.


OBJECTIVE
To estimate the incremental clinical and economic outcomes associated with the use of antiseptic-impregnated vs standard catheters.


METHODS
Decision analytic model using data from randomized controlled trials, meta-analyses, and case-control studies, as well as safety data from the US Food and Drug Administration.


METHODS
A hypothetical cohort of hospitalized patients at high risk for catheter-related infections (eg, patients in intensive care units, immunosuppressed patients, and patients receiving total parenteral nutrition) requiring use of a central venous catheter.


METHODS
Short-term use (2-10 days) of chlorhexidine-silver sulfadiazine-impregnated multilumen central venous catheters and nonimpregnated catheters.


METHODS
Expected incidence of CR-BSI and death attributable to antiseptic-impregnated and standard catheter use; direct medical costs for both types of catheters.


RESULTS
In the base-case analysis, use of antiseptic-impregnated catheters resulted in a decrease in the incidence of CR-BSI of 2.2% (5.2% for standard vs 3.0% for antiseptic-impregnated catheters), a decrease in the incidence of death of 0.33% (0.78% for standard vs 0.45% for antiseptic-impregnated), and a decrease in costs of $196 per catheter used ($532 for standard vs $336 for antiseptic-impregnated). The decrease in CR-BSI ranged from 1.2% to 3.4%, the decrease in death ranged from 0.09% to 0.78%, and the costs saved ranged from $68 to $391 in a multivariate sensitivity analysis.


CONCLUSIONS
Our analyses suggest that use of chlorhexidine-silver sulfadiazine-impregnated central venous catheters in patients at high risk for catheter-related infections reduces the incidence of CR-BSI and death and provides significant saving in costs. Use of these catheters should be considered as part of a comprehensive nosocomial infection control program.
Veenstra
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Pharmaceutical Outcomes Research and Policy Program and Department of Pharmacy, University of Washington, Seattle 98195-7630, USA. veenstra@u.washington.edu
Saint
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Sullivan
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D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000191:economics*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D004866:Equipment Contamination; D006801:Humans; D017063:Outcome Assessment, Health Care; D011336:Probability; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000191:economics / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D014481:United States
D000891:Anti-Infective Agents, Local