Volume 13, Number 6—June 2007
Perspective
Economic Evaluation and Catheter-related Bloodstream Infections
and Nicholas Graves*†
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.