Cost-effectiveness of a central venous catheter care bundle.
BACKGROUND
A bundled approach to central venous catheter care is currently being promoted as an effective way of preventing catheter-related bloodstream infection (CR-BSI). Consumables used in the bundled approach are relatively inexpensive which may lead to the conclusion that the bundle is cost-effective. However, this fails to consider the nontrivial costs of the monitoring and education activities required to implement the bundle, or that alternative strategies are available to prevent CR-BSI. We evaluated the cost-effectiveness of a bundle to prevent CR-BSI in Australian intensive care patients.


RESULTS
A Markov decision model was used to evaluate the cost-effectiveness of the bundle relative to remaining with current practice (a non-bundled approach to catheter care and uncoated catheters), or use of antimicrobial catheters. We assumed the bundle reduced relative risk of CR-BSI to 0.34. Given uncertainty about the cost of the bundle, threshold analyses were used to determine the maximum cost at which the bundle remained cost-effective relative to the other approaches to infection control. Sensitivity analyses explored how this threshold alters under different assumptions about the economic value placed on bed-days and health benefits gained by preventing infection. If clinicians are prepared to use antimicrobial catheters, the bundle is cost-effective if national 18-month implementation costs are below $1.1 million. If antimicrobial catheters are not an option the bundle must cost less than $4.3 million. If decision makers are only interested in obtaining cash-savings for the unit, and place no economic value on either the bed-days or the health benefits gained through preventing infection, these cost thresholds are reduced by two-thirds.


CONCLUSIONS
A catheter care bundle has the potential to be cost-effective in the Australian intensive care setting. Rather than anticipating cash-savings from this intervention, decision makers must be prepared to invest resources in infection control to see efficiency improvements.
Halton
Kate A
KA
The Centre for Healthcare Related Infection Surveillance and Prevention, Brisbane, Queensland, Australia. k.halton@qut.edu.au
Cook
David
D
Paterson
David L
DL
Safdar
Nasia
N
Graves
Nicholas
N
D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D055499:Catheter-Related Infections / Q000191:economics* / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000191:economics*; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics; D003428:Cross Infection / Q000191:economics / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged