title: Intermittent self catheterisation with hydrophilic, gel reservoir, and non-coated catheters: a systematic review and cost effectiveness analysis.
abstract: OBJECTIVE
  To determine the most effective and cost effective type of catheter for patients performing intermittent self catheterisation in the community.
  
  
  METHODS
  Systematic review and meta-analysis. Results were incorporated into a probabilistic Markov model to compare lifetime costs and quality adjusted life years (QALYs).
  
  
  METHODS
  We searched Medline, Embase, and Cochrane and Cinahl databases from 2002 to 18 April 2011 to identify studies comparing hydrophilic, gel reservoir, and non-coated intermittent catheters. Earlier guidelines were used to identify papers published before 2002. To capture studies comparing clean and sterile non-coated intermittent self catheterisation, each database was searched from its date of inception to 18 April 2011.
  
  
  METHODS
  Clinical outcomes included symptomatic urinary tract infection (UTI), bacteraemia, mortality, patient preference or comfort, and number of catheters used. The economic model included downstream complications of UTI and cost effectiveness was calculated as incremental cost per QALY gained.
  
  
  RESULTS
  Eight studies were included in the systematic review. Most were conducted in patients with spinal cord injuries, and most of the included patients were men. People using gel reservoir and hydrophilic catheters were significantly less likely to report one or more UTIs compared with sterile non-coated catheters (absolute effect for gel reservoir = 149 fewer per 1000 (95% confidence interval -7 to 198), P=0.04; absolute effect for hydrophilic = 153 fewer per 1000 (-8 to 268), P=0.04). However, there was no difference between hydrophilic and sterile non-coated catheters when outcomes were measured as mean monthly UTIs (mean difference = 0.01 (-0.11 to 0.09), P=0.84) or total UTIs at 1 year (mean difference = 0.18 (-0.50 to 0.86), P=0.60). There was little difference in the incidence of one or more UTIs for people using clean versus sterile non-coated catheters (absolute effect = 12 fewer per 1000 (-134 to 146), P=0.86). Although the most effective, gel reservoir catheters cost >£54,350 per QALY gained and are therefore not cost effective compared with clean non-coated self catheterisation.
  
  
  CONCLUSIONS
  The type of catheter used for intermittent self catheterisation seems to make little difference to the risk of symptomatic UTI. Given large differences in resource use, clean non-coated catheters are most cost effective. However, because of limitations and gaps in the evidence base and the designation of non-coated catheters as single use devices, we recommend a precautionary principle should be adopted and that patients should be offered a choice between hydrophilic and gel reservoir catheters.
authors.affiliation: Royal College of Physicians, National Clinical Guideline Centre, London NW1 4LE, UK.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Bermingham
authors.forename: Sarah
authors.initials: S
authors.lastname: Hodgkinson
authors.forename: Sue
authors.initials: S
authors.lastname: Wright
authors.forename: Ellie
authors.initials: E
authors.lastname: Hayter
authors.forename: Julian
authors.initials: J
authors.lastname: Spinks
authors.forename: Carol
authors.initials: C
authors.lastname: Pellowe
mesh_terms: D000553:Ambulatory Care / Q000191:economics; D057785:Catheters / Q000009:adverse effects / Q000191:economics*; D003153:Community Health Services / Q000191:economics; D003362:Cost-Benefit Analysis; D004352:Drug Resistance, Microbial; D004867:Equipment Design / Q000191:economics; D005260:Female; D005782:Gels / Q000191:economics*; D006801:Humans; D008297:Male; D008390:Markov Chains; D057240:Patient Preference; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012648:Self Care / Q000009:adverse effects / Q000191:economics*; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000191:economics / Q000209:etiology / Q000517:prevention & control; D001745:Urinary Bladder Diseases / Q000191:economics / Q000628:therapy; D014546:Urinary Catheterization / Q000191:economics* / Q000379:methods; D014552:Urinary Tract Infections / Q000191:economics / Q000209:etiology* / Q000517:prevention & control
chemical_list: D005782:Gels