Volume 13, Number 6—June 2007
Economic Evaluation and Catheter-related Bloodstream Infections
|Intervention||Comparator||Analysis||Perspective||Sensitivity analysis||Time horizon||Hospitalized patients||Ref.|
|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|
|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|
|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.