Volume 13, Number 6—June 2007
Perspective
Economic Evaluation and Catheter-related Bloodstream Infections
and Nicholas Graves*†Table 2
Summary of economic evaluations of interventions to prevent CR-BSI included in the review*
| Intervention | Comparator | Analysis | Perspective | Sensitivity analysis | Time horizon | Hospitalized patients | Ref. |
|---|---|---|---|---|---|---|---|
| Antimicrobial catheters | |||||||
| MR CVC | CHG-SSD CVC | CUA | HC payer | PROB, OW, SC | Patient lifetime | Adults at high risk for CR-BSI likely to require a triple-lumen, noncuffed CVC for >3 d | 27 |
| MR CVC and CHG-SSD CVC | Standard CVC | CEA | HC payer | OW, SC, TH | Duration hospitalized | Critically ill patients requiring a CVC expected to be placed >48 h | 29 |
| CHG-SSD CVC | Standard CVC | CEA | HC payer | PROB, OW, SC, TH | Duration hospitalized | Patients at high risk for catheter-related infections requiring short-term use (2–10 d) of multilumen CVCs | 30 |
| Aseptic technique | |||||||
| MSB at CVC insertion | Less stringent asepsis | CEA | Hospital | OW, SC | Duration hospitalized | Patients requiring short-term multilumen CVC (specifically, those in ICU, with immunosuppression, or receiving TPN) | 26 |
| Skin preparation and dressing | |||||||
| CHG skin prep | PI skin preparation | CEA | Hospital | PROB, OW, SC | Duration hospitalized | Patients requiring either a PVC or CVC (considered separately) for short-term use (<10 d) | 23 |
| CHG dressing | Standard dressing | CEA† | Hospital | OW, MW, SC | Duration hospitalized | Patients at high risk for catheter-related infections requiring short-term use (2–10 d) of multilumen CVCs | 24 |
| Total parenteral nutrition | |||||||
| TPN commercial bags | TPN glass bottles | CMA/CEA | Hospital | MW, TH | Duration hospitalized | Patients receiving TPN through catheter for severe bowel dysfunction secondary to Crohn disease, medical ICU patients, and surgical ICU patients | 25 |
| Replacement regimen | |||||||
| Optimal CVC change regimen (10 d, 5 d) | 3-d change regimen | CEA | Hospital | OW, MW, TH | Duration catheterized | 65-year-old man in ICU with reversible disease process | 28 |
*Except for the study in reference 25, which used a regression model, all studies used a decision tree. CR-BSI, catheter-related bloodstream infections; Ref., reference; MR, minocycline and rifampicin; CVC, central venous catheter; CHG-SSD, chlorhexidine gluconate/silver sulfadiazine; CUA, cost-utility analysis; HC, healthcare; PROB, probabilistic sensitivity analysis; OW, one way; SC, scenario; CEA, cost-effectiveness analysis; TH, threshold; MSB, maximal sterile barriers; ICU, intensive-care unit; TPN, total parenteral nutrition; PI, povidone-iodine; CMA, cost-minimization analysis; MW, multi way.
†Crawford et al. (24) identified their evaluation as a cost-benefit analysis (CBA) but they conducted a cost-effectiveness analysis with health outcomes multiplied by a dollar value to produce a monetary valuation of health benefits.
