Which antimicrobial impregnated central venous catheter should we use? Modeling the costs and outcomes of antimicrobial catheter use.
BACKGROUND
Catheter-related bloodstream infections are costly and associated with substantial morbidity and mortality. Trials suggest that central venous catheters impregnated with minocycline/rifampin, although more expensive, are clinically superior to chlorhexidine/silver sulfadiazine impregnated catheters. It remains unclear whether minocycline/rifampin catheters are cost-effective for all high-risk patients or only those requiring longer-term catheterization.


METHODS
We developed a series of decision models with patient-level clinical trial data to determine whether minocycline/rifampin catheters are cost-effective for patients requiring various durations of catheterization. We calculated incremental cost-effectiveness ratios for patients catheterized for durations ranging from 1 to 25 days.


RESULTS
The data were too sparse to estimate cost-effectiveness for patients catheterized less than 8 days. The probability that minocycline/rifampin catheters were cost-effective compared with chlorhexidine/silver sulfadiazine catheters in patients catheterized for 8 days was 91%. The probability that the minocycline/rifampin catheters in patients catheterized 13 days or longer resulted in cost savings was more than 95%.


CONCLUSIONS
Our analysis suggests that central venous catheters coated with minocycline/rifampin are cost-effective for patients catheterized for at least 1 week and lead to overall cost savings when patients are catheterized for 2 weeks or longer. Policies for the use of antimicrobial catheters in high-risk patients should reflect patients' expected duration of catheterization.
Marciante
Kristin D
KD
Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle WA 98195, USA.
Veenstra
David L
DL
Lipsky
Benjamin A
BA
Saint
Sanjay
S
D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000191:economics*; D016470:Bacteremia / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D002408:Catheters, Indwelling / Q000191:economics* / Q000382:microbiology; D002710:Chlorhexidine / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D016503:Drug Delivery Systems; D006801:Humans; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012293:Rifampin / Q000008:administration & dosage / Q000191:economics*; D012680:Sensitivity and Specificity; D012837:Silver Sulfadiazine / Q000008:administration & dosage / Q000191:economics; D013997:Time Factors; D014481:United States
D000890:Anti-Infective Agents; D008911:Minocycline; D002710:Chlorhexidine; D012293:Rifampin; D012837:Silver Sulfadiazine