Cost-Effectiveness Analysis of a Transparent Antimicrobial Dressing for Managing Central Venous and Arterial Catheters in Intensive Care Units
Franck Maunoury, Anastasiia Motrunich, Maria Palka-Santini, Stéphanie F Bernatchez, Stéphane Ruckly, Jean-François Timsit, Franck Maunoury, Anastasiia Motrunich, Maria Palka-Santini, Stéphanie F Bernatchez, Stéphane Ruckly, Jean-François Timsit
Abstract
Objective: To model the cost-effectiveness impact of routine use of an antimicrobial chlorhexidine gluconate-containing securement dressing compared to non-antimicrobial transparent dressings for the protection of central vascular lines in intensive care unit patients.
Design: This study uses a novel health economic model to estimate the cost-effectiveness of using the chlorhexidine gluconate dressing versus transparent dressings in a French intensive care unit scenario. The 30-day time non-homogeneous markovian model comprises eight health states. The probabilities of events derive from a multicentre (12 French intensive care units) randomized controlled trial. 1,000 Monte Carlo simulations of 1,000 patients per dressing strategy are used for probabilistic sensitivity analysis and 95% confidence intervals calculations. The outcome is the number of catheter-related bloodstream infections avoided. Costs of intensive care unit stay are based on a recent French multicentre study and the cost-effectiveness criterion is the cost per catheter-related bloodstream infections avoided. The incremental net monetary benefit per patient is also estimated.
Patients: 1000 patients per group simulated based on the source randomized controlled trial involving 1,879 adults expected to require intravascular catheterization for 48 hours.
Intervention: Chlorhexidine Gluconate-containing securement dressing compared to non-antimicrobial transparent dressings.
Results: The chlorhexidine gluconate dressing prevents 11.8 infections /1,000 patients (95% confidence interval: [3.85; 19.64]) with a number needed to treat of 85 patients. The mean cost difference per patient of €141 is not statistically significant (95% confidence interval: [€-975; €1,258]). The incremental cost-effectiveness ratio is of €12,046 per catheter-related bloodstream infection prevented, and the incremental net monetary benefit per patient is of €344.88.
Conclusions: According to the base case scenario, the chlorhexidine gluconate dressing is more cost-effective than the reference dressing.
Trial registration: This model is based on the data from the RCT registered with www.clinicaltrials.gov (NCT01189682).
Conflict of interest statement
Competing Interests: This study was funded by 3M Company, http://solutions.3mdeutschland.de/wps/portal/3M/de_DE/EU2/Country/. MPS and SFB are employees of 3M Company and had a role in preparation of the manuscript. 3M Tegaderm CHG is a product marketed by 3M Company. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.
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References
- Soufir L, Timsit JF, Mahe C, Carlet J, Regnier B, Chevret S. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study. Infect Control Hosp Epidemiol. 1999;20:396–401.
- Renaud B, Brun-Buisson C. ICU-Bacteremia Study Group. Outcomes of primary and catheter-related bacteremia. A cohort and case-control study in critically ill patients. Am J Respir Crit Care Med. 2001;163:1584–90.
- O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011;39(4 Suppl 1):S1–34. 10.1016/j.ajic.2011.01.003 .
- Timsit JF, Dubois Y, Minet C, Bonadona A, Lugosi M, Ara-Somohano C, et al. New materials and devices for preventing catheter-related infections. Annals of Intensive Care. 2011;1:34 10.1186/2110-5820-1-34
- Eggimann P, Harbarth S, Constantin MN, Touveneau S, Chevrolet JC, Pittet D. Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet. 2000;355:1864–8.
- Coopersmith CM, Rebmann TL, Zack JE, Ward MR, Corcoran RM, Schallom ME, et al. Effect of an education program on decreasing catheter-related bloodstream infections in the surgical intensive care unit. Crit Care Med. 2002;30:59–64.
- Suetens C, Morales I, Savey A, Palomar M, Hiesmayr M, Lepape A, et al. European surveillance of ICU-acquired infections (HELICS-ICU): methods and main results. J Hosp Infect. 2007;65:171–3.
- Poujol I, Thiolet JM, Bernet C, Carbonne A, Dumartin C, Sénéchal H, et al. Notification of healthcare-associated infections, France, 2007–2009. BEH. 2010;October 2010:38–9.
- Davidoff F. Heterogeneity Is Not Always Noise. JAMA. 2009;302(23):2580–6. 10.1001/jama.2009.1845
- Timsit JF, L'Hériteau F, Lepape A, Français A, Ruckly S, Venier AG, et al. A multicentre analysis of catheter-related infection based on a hierarchical model. Intensive Care Med. 2012;38(10):1662–72.
- Pronovost PJ, Goeschel CA, Colantuoni E, Watson S, Lubomski LH, Berenholtz SM, et al. Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. BMJ. 2010;340:c309 10.1136/bmj.c309
- Mermel LA. What is the predominant source of intravascular catheter infections? Clin Infect Dis. 2011;52(2):211–2. 10.1093/cid/ciq108
- Timsit JF, Mimoz O, Mourvillier B, Souweine B, Garrouste-Orgeas M, Alfandari S, et al. Randomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults. Am J Respir Crit Care Med. 2012;186(12):1272–8. 10.1164/rccm.201206-1038OC .
- Timsit JF, Schwebel C, Bouadma L, Geffroy A, Garrouste-Orgeas M, Pease S, et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults. J Am Med Assoc. 2009;301(12):1231–41.
- French National Authority for Health. Choices in Methods for Economic Evaluation: a methodological guide. (2012). Accessed 15 Jul 2013. 2012.
- Maruotti A, Rocci R. A mixed non-homogeneous hidden Markov model for categorical data, with application to alcohol consumption. Stat Med. 2012;31:871–86. 10.1002/sim.4478
- Nunes B, Natário I, Lucília Carvalho M. Nowcasting influenza epidemics using non-homogeneous hidden Markov models. Stat Med. 2013;32:2643–60. 10.1002/sim.5670
- Liquet B, Timsit JF, Rondeau V. Investigating hospital heterogeneity with a multi-state frailty model: application to nosocomial pneumonia disease in intensive care units. BMC Med Res Methodol. 2012;12:79 10.1186/1471-2288-12-79
- Timsit JF. Réactualisation de la douzième conférence de consensus de la Société de réanimation de langue française (SRLF): infections liées aux cathéters veineux centraux en réanimation (Updating of the 12th consensus conference of the Société de Réanimation de langue française (SRLF): Catheter related infections in the intensive care unit). Ann Fr Anesth Reanim. 2005;24(3):315–22. 10.1016/j.annfar.2004.12.022 .
- Weinstein MC, Fineberg HV, Elstein AS, Frazier HS, Neuhauser D, Neutra RR. Clinical Decision Analysis. Philadelphia: WB Saunders Company; 1980.
- Beck JR, Pauker SG. The Markov Process in Medical Prognosis. Med Decis Making. 1983;3(4):419
- Sonnenberg FA, Beck JR. Markov models in medical decision making: a practical guide. Med Decis Making. 1993;13(4):322–38.
- Janssen J, Limnios N. Semi-markov models and applications. Norwell: Kluwer Academic Publishers; 1999. 432 p.
- Hastings WK. Monte Carlo Sampling Methods Using Markov Chains and Their Applications. Biometrika. 1970;57(1):97–109.
- Schwebel C, Lucet JC, Vesin A, Arrault X, Calvino-Gunther S, Bouadma L, et al. Economic evaluation of chlorhexidine-impregnated sponges for preventing catheter-related infections in critically ill adults in the Dressing Study. Crit Care Med. 2012;40(1):11–7. 10.1097/CCM.0b013e31822f0604 .
- Garrigues B. Étude CRRéa: Évaluation médico-économique du Coût Réel d’une journée en RÉAnimation (Medico-economic evaluation of the Real Cost of a day in ICU). 2010. Accessed 30 March 2015.
- Dimick JB, Pelz RK, Consunji R, Swoboda SM, Hendrix CW, Lipsett PA. Increased resource use associated with catheter-related bloodstream infection in the surgical intensive care unit. ArchSurg. 2001;136(229):234
- Ferreira FL, Bota DP, Bross A, Mélot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA. 2001;286(14):1754–8.
- Weinstein MC, O'Brien B, Hornberger J, Jackson J, Johannesson M, McCabe C, et al. Principles of good practice of decision analytic modeling in health care evaluation: Report of the ISPOR Task Force on Good Research Practices-Modeling Studies. Value Health. 2003;6:9–17.
- Gelfand AE. Gibbs sampling. Journal of the American Statistical Association. 2000;95(452):1300–4.
- Saint S, Veenstra DL, Lipsky BA. The clinical and economic consequences of nosocomial central venous catheter-related infection: are antimicrobial catheters useful? Infect Control Hosp Epidemiol. 2000;21:375–80.
- Wenzel RP, Edmond MB. The impact of hospital-acquired bloodstream infections. Emerg Infect Dis. 2001;7:174–7.
- Crawford AG, Fuhr JP, Rao B. Cost—Benefit Analysis of Chlorhexidine Gluconate Dressing in the Prevention of Catheter-Related Bloodstream Infections. Infect Control Hosp Epidemiol. 2004;25(8):668–74.
- Ye X, Rupnow M, Bastide P, Lafuma A, Ovington L, Jarvis WR. Economic impact of use of chlorhexidine-impregnated sponge dressing for prevention of central line-associated infections in the United States. Am J Infect Control. 2011;39(8):647–54. 10.1016/j.ajic.2010.11.008 .
- Veenstra DL, Saint S, Sullivan SD. Cost-effectiveness of antiseptic impregnated central venous catheters for the prevention of catheter- related bloodstream infection. JAMA. 1999;282:554–60.
- Frank U, Chojnacki T, Dettenkofer M, Daschner FD. Cost-effectiveness of an antiseptic-impregnated central venous catheter in the ICU. Intensive Care Med. 2003;29:139
- Claxton K, Posnett J. An economic approach to clinical trial design and research priority-setting. Health Econ. 1996;5:513–24.
- Tambour M, Zethraeus N, Johannesson M. A note on confidence intervals in cost-effectiveness analysis. Int J Technol Assess Health Care. 1998;14(3):467–71.
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