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Volume 13, Number 6—June 2007

Perspective

Economic Evaluation and Catheter-related Bloodstream Infections

Kate Halton*†Comments to Author  and Nicholas Graves*†
Author affiliations: *The Centre for Healthcare Related Infection Surveillance and Prevention, Brisbane, Queensland, Australia; †Queensland University of Technology, Brisbane, Queensland, Australia

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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.

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