Cost effectiveness of antimicrobial catheters for adults requiring short-term catheterisation in hospital

Abstract

Catheter-associated urinary tract infection (CAUTI) is the second most common cause of hospital-acquired infection. A number of strategies have been put forward to prevent CAUTI, including the use of antimicrobial catheters. We aimed to assess whether the use of either a nitrofurazone-impregnated or a silver alloy-coated catheter was cost-effective compared with standard polytetrafluoroethylene (PTFE)-coated catheters. A decision-analytic model using data from a clinical trial conducted in the United Kingdom was used to calculate the incremental cost per quality-adjusted life-year (QALY). We assumed that differences in costs and QALYs were driven by difference in risk of acquiring a CAUTI. Routine use of nitrofurazone-impregnated catheters was, on average, £7 (€9) less costly than use of the standard catheter over 6 wk. There was a >70% chance that use of nitrofurazone catheters would be cost saving and an 84% chance that the incremental cost per QALY would be less than £30 000 (€36 851; a commonly used threshold for society's willingness to pay). Silver alloy-coated catheters were very unlikely to be cost-effective. The model's prediction, although associated with uncertainty, was that nitrofurazone-impregnated catheters may be cost-effective in the UK National Health System or a similar setting.

Keywords: Antimicrobial catheters; Catheter-associated symptomatic urinary tract infection; Cost effectiveness; Costs; Decision-analytic model; Randomised controlled trial.