Catheter-related blood stream infections (CRBSIs) remain a challenge in critical care. Two central venous catheters (CVCs) impregnated with either chlorhexidine-silver sulfadiazine (CSS) or rifampin/minocycline (RM) are commercially available. The cost-effectiveness of these treated CVCs has not been determined.
We modeled the cost and efficacy of the coated CVCs at preventing CRBSIs. The primary outcome was the incremental cost (or savings) to prevent one additional CRBSI. Model estimates were derived from prospective trials of the CSS and RM CVCs and from studies describing the costs of CRBSIs. We compared each newer CVC to a standard, uncoated CVC and to each other. The incremental cost-effectiveness of the treated CVCs was calculated as the savings resulting from CRBSIs averted less the additional costs of the newer devices.
In the base-case we assumed the incidence of CRBSIs was 3.3% with traditional CVCs and that the CSS and RM CVC conferred relative risk reductions of 60% and 85%, respectively. Despite their higher costs, both novel CVCs yield savings. Employing either treated CVCs saves approximately $10,000 per CRBSI prevented (relative to standard catheters). The RM CVC saved nearly $9,600 per CRBSI averted and $81 per patient in the cohort when compared to the CSS CVC. For sensitivity analysis we adjusted all model variables by 50% individually and then simultaneously. The model was moderately sensitive to the cost of a CRBSI. However, with all inputs skewed by 50% against both the CSS and RM CVC, these devices remained economically attractive. Under this scenario, use of either treated device remained less costly. Threshold analysis showed that the newer CVCs were cost-saving until either the incidence of CRBSIs fell below 0.6% or the cost of a CRBSI drops to approximately $1300.CONCLUSIONS: Both the RM and CSS CVC are financially attractive options for prevention of CRBSIs. The RM CVC generates more savings than the CSS CVC.
Broader use of treated CVCs is warranted based on their cost-effectiveness.
A.F. Shorr, None.