Cost effectiveness of antimicrobial catheters in the intensive care unit: Addressing uncertainty in the decision

Halton, Kate A., Cook, David A., Whitby, Michael, Paterson, David L. and Graves, Nicholas (2009) Cost effectiveness of antimicrobial catheters in the intensive care unit: Addressing uncertainty in the decision. Critical Care, 13 2: R35.1-R35.10. doi:10.1186/cc7744


Author Halton, Kate A.
Cook, David A.
Whitby, Michael
Paterson, David L.
Graves, Nicholas
Title Cost effectiveness of antimicrobial catheters in the intensive care unit: Addressing uncertainty in the decision
Journal name Critical Care   Check publisher's open access policy
ISSN 1364-8535
1466-609X
Publication date 2009-03
Year available 2009
Sub-type Article (original research)
DOI 10.1186/cc7744
Open Access Status DOI
Volume 13
Issue 2
Start page R35.1
End page R35.10
Total pages 10
Editor Jean-Louis Vincent
Place of publication Philadelphia, PA, U.S.A.
Publisher Current Science
Collection year 2010
Language eng
Subject C1
920109 Infectious Diseases
110309 Infectious Diseases
Formatted abstract
Introduction: Some types of antimicrobial-coated central venous catheters (A-CVC) have been shown to be cost effective in preventing catheter-related bloodstream infection (CR-BSI). However, not all types have been evaluated, and there are concerns over the quality and usefulness of these earlier studies. There is uncertainty amongst clinicians over which, if any, A-CVCs to use. We re-evaluated the cost effectiveness of all commercially available A-CVCs for prevention of CR-BSI in adult intensive care unit (ICU) patients.

Methods: We used a Markov decision model to compare the cost effectiveness of A-CVCs relative to uncoated catheters. Four catheter types were evaluated: minocycline and rifampicin (MR)-coated catheters, silver, platinum and carbon (SPC)-impregnated catheters, and two chlorhexidine and silver sulfadiazine-coated catheters; one coated on the external surface (CH/SSD (ext)) and the other coated on both surfaces (CH/SSD (int/ext)). The incremental cost per quality-adjusted life year gained and the expected net monetary benefits were estimated for each. Uncertainty arising from data estimates, data quality and heterogeneity was explored in sensitivity analyses.

Results:
The baseline analysis, with no consideration of uncertainty, indicated all four types of A-CVC were cost-saving relative to uncoated catheters. MR-coated catheters prevented 15 infections per 1,000 catheters and generated the greatest health benefits, 1.6 quality-adjusted life years, and cost savings (AUD $130,289). After considering uncertainty in the current evidence, the MR-coated catheters returned the highest incremental monetary net benefits of AUD $948 per catheter; however there was a 62% probability of error in this conclusion. Although the MR-coated catheters had the highest monetary net benefits across multiple scenarios, the decision was always associated with high uncertainty.

Conclusions:
Current evidence suggests that the cost effectiveness of using A-CVCs within the ICU is highly uncertain. Policies to prevent CR-BSI amongst ICU patients should consider the cost effectiveness of competing interventions in the light of this uncertainty. Decision makers would do well to consider the current gaps in knowledge and the complexity of producing good quality evidence in this area.
Keyword Central venous catheters
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article number: R35

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
2010 Higher Education Research Data Collection
ERA 2012 Admin Only
 
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Citation counts: TR Web of Science Citation Count  Cited 21 times in Thomson Reuters Web of Science Article | Citations
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Created: Thu, 03 Sep 2009, 08:02:57 EST by Mr Andrew Martlew on behalf of UQ Centre for Clinical Research