title: The potential clinical and economic benefits of silver alloy urinary catheters in preventing urinary tract infection.
abstract: 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.
authors.affiliation: 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
authors.forename: S
authors.initials: S
authors.lastname: Saint
authors.forename: D L
authors.initials: DL
authors.lastname: Veenstra
authors.forename: S D
authors.initials: SD
authors.lastname: Sullivan
authors.forename: C
authors.initials: C
authors.lastname: Chenoweth
authors.forename: A M
authors.initials: AM
authors.lastname: Fendrick
mesh_terms: 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*
chemical_list: D000497:Alloys; D000890:Anti-Infective Agents; D012834:Silver