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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

Main Article

Table 3

Results of economic evaluations of interventions to prevent CR-BSI*

Intervention Estimated absolute incremental benefits
Estimated incremental cost Cost/benefit ratio Sensitivity analysis Ref.
Incidence CR-BSI, % Mortality incidence, %
Baseline: CHG-SSD catheter Variable Not stated Not stated 27
MR catheter† −0.7 0.009 QALYs (–0.009, 0.016) –$83
($109, –$205) Cost saving Robust
Baseline: standard catheter 3.30 $469 29
CHG-SSD catheter −1.94 –$222 Cost saving Robust
MR catheter −2.79 –$314 Cost saving Robust
Baseline: standard catheter 5.20 0.78 $710 30
CHG-SSD catheter −2.20
(−1.2, −3.4) −0.33
(−0.09, −0.78) –$262
(–$91, –$522) Cost saving Robust
Baseline: less stringent asepsis 5.30 0.80 $676 26
Maximal sterile barriers −2.49 −0.38 –$274 Cost saving Robust
Baseline: Povidone-iodine skin preparation 3.1 0.46 $265 23
Chlorhexidine gluconate −1.6
(−0.6, −2.5) −0.23
(−0.07, −0.47) –$134
(–$21, –$286) Cost saving Robust
Baseline: standard dressing 5.00 0.05 $514 24
Chlorhexidine dressing§ −2.63 −0.03 –$259 Cost saving Robust
Baseline: glass TPN bottles 10.0 0.50 Not stated 25
TPN bags¶ −6.67 −0.33 Not stated $28,326/life saved Variable
Baseline: 5 d 0.92 $1,398 Not clear from source what reported cost-effectiveness ratios represented 28
3 d −0.02 $8 Variable
10 d −0.13 $63 Variable

*All estimates have been adjusted to 2005 US dollars. Values in parentheses are 95% confidence intervals. CR-BSI, catheter-related bloodstream infections; mortality, CR-BSI attributable mortality; CHG-SSD, chlorhexidine gluconate/silver sulfadiazine; QALYs, quality-adjusted life year; MR, minocycline and rifampicin; TPN, total parenteral nutrition.
†Refers to results for an 8-d duration of catheterization; intervention was cost-saving for durations >8 d and could not be evaluated for <8 d.
‡Cost year for original analysis not stated; therefore, assumed 1 year before publication.
§Refers to results using baseline conservative assumptions of 5% CR-BSI incidence rate, 1% CR-BSI attributable mortality rate, and $8,000 incremental CR-BSI treatment cost.
¶Refers to results using baseline conservative assumptions of 10% CR-BSI incidence rate, 5% CR-BSI attributable mortality rate, and relative reduction in risk for CR-BSI of 0.33.

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