Cost-benefit analysis of chlorhexidine gluconate dressing in the prevention of catheter-related bloodstream infections.
OBJECTIVE
To compare the costs with the benefits of using chlorhexidine gluconate dressings on central venous catheters and to determine the effectiveness of these dressings in reducing local infections and catheter-related bloodstream infections (CRBSIs), costs, and mortality.


METHODS
Cost-benefit analysis using randomized, controlled trial data on chlorhexidine dressing prevention of local infection and CRBSI, data on cost of chlorhexidine dressing versus standard treatment, data on averted cost of treating local infection and CRBSI, and data on mortality attributable to CRBSI. Decision analysis evaluated averted CRBSI treatment cost per patient resulting from chlorhexidine dressing use. Sensitivity analyses demonstrated net benefit of chlorhexidine dressing, varying baseline rate of CRBSI, incremental cost of treating CRBSI, and number of catheters, and evaluated mortality preventable through chlorhexidine dressing use, varying baseline rate of CRBSI, number of catheters, and mortality attributable to CRBSI.


METHODS
Patients of all Philadelphia area hospitals and one Philadelphia academic medical center.


RESULTS
Estimated potential annual U.S. net benefits from chlorhexidine dressing use ranged from $275 million to approximately $1.97 billion. Cost-benefit findings persisted in sensitivity analyses varying baseline rate of CRBSI, incremental cost of treating CRBSI, and overall number of catheters used. Preventable mortality analyses showed potential decreases of between 329 and 3,906 U.S. deaths annually as a result of nationwide use of chlorhexidine dressing.


CONCLUSIONS
Chlorhexidine dressings would reduce costs, local infections and CRBSIs, and deaths. Use of chlorhexidine dressings should be considered to prevent infections among patients with catheters.
Crawford
Albert G
AG
Department of Health Policy, Jefferson Medical College, Suite 115, 1015 Walnut Street, Philadelphia, PA 19107, USA.
Fuhr
Joseph P
JP
Rao
Bhaskar
B
D000891:Anti-Infective Agents, Local / Q000191:economics* / Q000627:therapeutic use; D001458:Bandages / Q000191:economics*; D002404:Catheterization / Q000009:adverse effects*; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004866:Equipment Contamination / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D018805:Sepsis / Q000188:drug therapy / Q000191:economics / Q000209:etiology* / Q000517:prevention & control*; D016019:Survival Analysis
D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine