Cost-effectiveness of a central venous catheter care bundle

Halton, KA, Cook, D, Paterson, DL, Safdar, N and Graves, N (2010) Cost-effectiveness of a central venous catheter care bundle. PLoS One, 5 9: e12815-1-e12815-11. doi:10.1371/journal.pone.0012815

Author Halton, KA
Cook, D
Paterson, DL
Safdar, N
Graves, N
Title Cost-effectiveness of a central venous catheter care bundle
Journal name PLoS One   Check publisher's open access policy
ISSN 1932-6203
Publication date 2010-09
Sub-type Article (original research)
DOI 10.1371/journal.pone.0012815
Open Access Status DOI
Volume 5
Issue 9
Start page e12815-1
End page e12815-11
Total pages 11
Place of publication San Francisco, United States
Publisher Public Library of Science
Collection year 2011
Language eng
Formatted abstract
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
Methods and Findings: 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.
© 2010 Halton et al.

Keyword Blood-stream infections
Hospital-acquired infection
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article# e12815, pp.1-11

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
Official 2011 Collection
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Citation counts: TR Web of Science Citation Count  Cited 21 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 20 times in Scopus Article | Citations
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Created: Sun, 10 Oct 2010, 00:01:29 EST