Journal Reviews
January 1, 2000 2 minutes read
Journal Reviews
Antiseptic-coated catheters reduce infection
Veenstra DL, Saint S, Sullivan D. Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection. JAMA 1999; 282:554-560.
The use of chlorhexidine-silver sulfadiazine-impregnated central venous catheters in patients at high risk for catheter-related infections reduces the incidence of catheter-related blood stream infection (CR-BSI) and death and provides significant saving in costs, the authors found.
"Use of these catheters should be considered as part of a comprehensive nosocomial infection control program," they recommended. CR-BSI occurs with 3% to 7% of catheters and affects more than 200,000 patients per year in the United States. The attributable mortality of CR-BSI ranges from approximately 10% to 25%, and CR-BSI has been associated with significant increases in the length of hospitalization and medical care costs.
BSI decrease of 2.2%
To estimate the incremental clinical and economic outcomes associated with the use of antiseptic-impregnated vs. standard catheters, the authors constructed a model based on data from randomized controlled trials, meta-analyses, and case-control studies. They used a hypothetical cohort of hospitalized patients at high risk for catheter-related infections (e.g., patients in intensive care units, immunosuppressed patients, and patients receiving total parenteral nutrition) requiring use of a central venous catheter.
In the analysis, use of antiseptic-impregnated catheters resulted in a decrease in the incidence of CR-BSI of 2.2% (5.2% for standard vs. 3.0% for antiseptic-impregnated catheters); a decrease in the incidence of death of 0.33% (0.78% for standard vs. 0.45% for antiseptic-impregnated); and a decrease in costs of $196 per catheter used ($532 for standard vs. $336 for antiseptic-impregnated). The decrease in CR-BSI ranged from 1.2% to 3.4%, the decrease in death ranged from 0.09% to 0.78%, and the costs saved ranged from $68 to $391 in a multivariate sensitivity analysis.
"Our analysis was conducted from the perspective of a health care payer," the authors conclude. "An analysis from the societal perspective, which might include indirect costs such as patient’s time lost from work, would result in even greater costs saved than reported here."
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