The potential clinical and economic benefits of silver alloy urinary catheters in preventing urinary tract infection.
BACKGROUND
Catheter-associated urinary tract infection (UTI) is associated with increased morbidity, mortality, and costs. A recent meta-analysis concluded that silver alloy catheters reduce the incidence of UTI by 3-fold; however, clinicians must decide whether the efficacy of such catheters is worth the extra per unit cost of $5.30.


OBJECTIVE
To assess the clinical and economic impact of using silver alloy urinary catheters in hospitalized patients.


METHODS
The decision model, performed from the health care payer's perspective, evaluated a simulated cohort of 1000 hospitalized patients on general medical, surgical, urologic, and intensive care services requiring short-term urethral catheterization (2-10 days). We compared 2 catheterization strategies: silver alloy catheters and standard (noncoated) urinary catheters. Outcomes included the incidence of symptomatic UTI and bacteremia and direct medical costs.


RESULTS
In the base-case analysis, use of silver-coated catheters led to a 47% relative decrease in the incidence of symptomatic UTI from 30 to 16 cases per 1000 patients (number needed to treat = 74) and a 44% relative decrease in the incidence of bacteremia from 4.5 to 2.5 cases per 1000 patients (number needed to treat = 500) compared with standard catheters. Use of silver alloy catheters resulted in estimated cost savings of $4.09 per patient compared with standard catheter use ($20.87 vs $16.78). In a multivariate sensitivity analysis using Monte Carlo simulation, silver-coated catheters provided clinical benefits over standard catheters in all cases and cost savings in 84% of cases.


CONCLUSIONS
Using silver alloy catheters in hospitalized patients requiring short-term urinary catheterization reduces the incidence of symptomatic UTI and bacteremia, and is likely to produce cost savings compared with standard catheters.
Saint
S
S
Division of General Medicine, Department of Internal Medicine, University of Michigan, 3116 Taubman Center, Campus Box 0376, Ann Arbor, MI 48109-0376, USA. saint@umich.edu
Veenstra
D L
DL
Sullivan
S D
SD
Chenoweth
C
C
Fendrick
A M
AM
D000497:Alloys; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000209:etiology; D003362:Cost-Benefit Analysis; D003657:Decision Making; D003663:Decision Trees; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015994:Incidence; D009010:Monte Carlo Method; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D012306:Risk; D012680:Sensitivity and Specificity; D012834:Silver; D014481:United States; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000191:economics* / Q000295:instrumentation; D014552:Urinary Tract Infections / Q000150:complications / Q000191:economics* / Q000209:etiology / Q000517:prevention & control*
D000497:Alloys; D000890:Anti-Infective Agents; D012834:Silver