title: Cost-Effectiveness Analysis of a Transparent Antimicrobial Dressing for Managing Central Venous and Arterial Catheters in Intensive Care Units.
abstract: OBJECTIVE
  To model the cost-effectiveness impact of routine use of an antimicrobial chlorhexidine gluconate-containing securement dressing compared to non-antimicrobial transparent dressings for the protection of central vascular lines in intensive care unit patients.
  
  
  METHODS
  This study uses a novel health economic model to estimate the cost-effectiveness of using the chlorhexidine gluconate dressing versus transparent dressings in a French intensive care unit scenario. The 30-day time non-homogeneous markovian model comprises eight health states. The probabilities of events derive from a multicentre (12 French intensive care units) randomized controlled trial. 1,000 Monte Carlo simulations of 1,000 patients per dressing strategy are used for probabilistic sensitivity analysis and 95% confidence intervals calculations. The outcome is the number of catheter-related bloodstream infections avoided. Costs of intensive care unit stay are based on a recent French multicentre study and the cost-effectiveness criterion is the cost per catheter-related bloodstream infections avoided. The incremental net monetary benefit per patient is also estimated.
  
  
  METHODS
  1000 patients per group simulated based on the source randomized controlled trial involving 1,879 adults expected to require intravascular catheterization for 48 hours.
  
  
  METHODS
  Chlorhexidine Gluconate-containing securement dressing compared to non-antimicrobial transparent dressings.
  
  
  RESULTS
  The chlorhexidine gluconate dressing prevents 11.8 infections /1,000 patients (95% confidence interval: [3.85; 19.64]) with a number needed to treat of 85 patients. The mean cost difference per patient of €141 is not statistically significant (95% confidence interval: [€-975; €1,258]). The incremental cost-effectiveness ratio is of €12,046 per catheter-related bloodstream infection prevented, and the incremental net monetary benefit per patient is of €344.88.
  
  
  CONCLUSIONS
  According to the base case scenario, the chlorhexidine gluconate dressing is more cost-effective than the reference dressing.
  
  
  BACKGROUND
  This model is based on the data from the RCT registered with www.clinicaltrials.gov (NCT01189682).
authors.affiliation: Statesia, Le Mans, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Maunoury
authors.affiliation: Statesia, Le Mans, France.
authors.forename: Anastasiia
authors.initials: A
authors.lastname: Motrunich
authors.affiliation: 3M Company, Neuss, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Palka-Santini
authors.affiliation: 3M Company, St. Paul, United States of America.
authors.forename: Stéphanie F
authors.initials: SF
authors.lastname: Bernatchez
authors.affiliation: Grenoble University Hospital, Grenoble, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ruckly
authors.affiliation: Grenoble University Hospital, Grenoble, France; IAME UMR1137-Team 5 Decision Sciences in Infectious Disease Prevention, Control and Care, Paris Diderot University-Inserm, Sorbonne Paris Cité, Paris, France; Paris Diderot University-Bichat University hospital-Medical and Infectious Diseases Intensive care unit, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000191:economics / Q000627:therapeutic use*; D001458:Bandages / Q000191:economics*; D055499:Catheter-Related Infections / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011336:Probability; D062666:Vascular Access Devices / Q000191:economics / Q000382:microbiology*
chemical_list: D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine