Cost-effectiveness analysis of bundled innovative devices versus standard approach in the prevention of unscheduled peripheral venous catheters removal due to complications in France

Franck Maunoury, Bertrand Drugeon, Matthieu Boisson, Nicolas Marjanovic, Raphael Couvreur, Olivier Mimoz, Jeremy Guenezan, CLEAN-3 Study, Franck Maunoury, Bertrand Drugeon, Matthieu Boisson, Nicolas Marjanovic, Raphael Couvreur, Olivier Mimoz, Jeremy Guenezan, CLEAN-3 Study

Abstract

The objective of the study was to perform a cost-effectiveness analysis of bundled devices (BDs) versus standard devices (SDs) for the prevention of unscheduled peripheral venous catheter (PVC) removal due to complication from a French investigator-initiated, open-label, single center, randomized-controlled, two-by-two factorial trial (CLEAN-3 study). A 14-day time non homogeneous semi-markovian model was performed to be fitted to longitudinal individual patient data from CLEAN-3 database. This model includes five health states and eight transitional events; a base case scenario, two scenario analyses and bootstrap sensitivity analyses were performed. The cost-effectiveness criterion was the cost per patient with unscheduled PVC removal avoided. 989 adult (age≥18 years) patients were analyzed to compare the BDs group (494 patients), and the SDs group (495 patients). The assessed intervention was a combination of closed integrated catheters, positive displacement needleless-connectors, disinfecting caps, and single-use prefilled flush syringes compared with the use of open catheters and three-way stopcocks for treatment administration. For the base case scenario, an unscheduled 1st PVC removal before discharge was significantly more frequent in the SDs group (235 patients (47.5%) in the SDs group and 172 patients (34.8%) in the BDs group, p = 0.00006). After adjustment for 1st catheter time, the number of patients with unscheduled PVC removal per day was of 16 (95%CI: 15; 18) patients (out of 100) in the BDs group and of 26 (95%CI: 24; 28) patients (out of 100) in the SDs group. The mean cost per patient (adjusted on catheter-time) was of €144 (95%CI: €135-€154) for patients in the SDs group versus €102 (95%CI: €95-€109) for patients in the BDs group; the mean saving per patient was of €42 (95%CI: €32-€54). As a consequence, the assessed BDs strategy was less costly and more effective than the SDs strategy. Trail registration: CLEAN-3 study is registered with ClinicalTrials.gov, NCT03757143.

Conflict of interest statement

OM & JG received personal fees from Becton Dickinson, funding for congress attendance, and research funding from Becton Dickinson. MB received personal fees from Becton Dickinson. All other investigators and authors declare no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1. Observed model structure from CLEAN-3…
Fig 1. Observed model structure from CLEAN-3 database (BDs strategy, SDs strategy)–Markov diagram.
BDs: Bundle of devices, SDs: Standard devices, PVC: Peripheral Venous Catheter.
Fig 2. Evolution of a multi-state model.
Fig 2. Evolution of a multi-state model.
As an example case study within the msm package, the process is observed, for instance, on four occasions (source: msm package [10]).
Fig 3. Probabilistic sensitivity analysis: Cost-effectiveness plane…
Fig 3. Probabilistic sensitivity analysis: Cost-effectiveness plane for the base case analysis.
PVC: Peripheral Venous Catheter.

References

    1. Rickard CM, Marsh N, Webster J, Runnegar N, Larsen E, McGrail MR, et al.. Dressings and securements for the prevention of peripheral intravenous catheter failure in adults (SAVE): a pragmatic, randomised controlled, superiority trial. The Lancet. 2018;392(10145):419–30. doi: 10.1016/S0140-6736(18)31380-1
    1. Helm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but Unacceptable: Peripheral IV Catheter Failure. J Infus Nurs. 2015;38(3):189–203. doi: 10.1097/NAN.0000000000000100
    1. Tuffaha HW, Rickard CM, Webster J, Marsh N, Gordon L, Wallis M, et al.. Cost-Effectiveness Analysis of Clinically Indicated Versus Routine Replacement of Peripheral Intravenous Catheters. Appl Health Econ Health Policy. 2014;12:51–8. doi: 10.1007/s40258-013-0077-2
    1. Lim S, Gangoli G, Adams E, Hyde R, Broder MS, Chang E, et al.. Increased Clinical and Economic Burden Associated With Peripheral Intravenous Catheter–Related Complications: Analysis of a US Hospital Discharge Database. INQUIRY. 2019;56:1–14. doi: 10.1177/0046958019875562
    1. Guenezan J, Marjanovic N, Drugeon B, Neill RO, Liuu E, Roblot F, et al.. Chlorhexidine plus alcohol versus povidone iodine plus alcohol, combined or not with innovative devices, for prevention of short-term peripheral venous catheter infection and failure (CLEAN 3 study): an investigator-initiated, open-label, single centre, randomised-controlled, two-by-two factorial trial. Lancet Infect Dis. 2021;21(7):1038–48. doi: 10.1016/S1473-3099(20)30738-6
    1. Choices in methods for economic evaluation–Haute Autorité de Santé. 2020;1–115.
    1. Weinstein MC, Fineberg HV, Elstein A, Frazier H, Neuhauser D, Neutra R, et al.. Clinical Decision Analysis. Med Decis Making. 1980;94–7.
    1. Beck JR, Pauker SG. The Markov Process in Medical Prognosis. Med Decis Making. 1983;3(4):419–58. doi: 10.1177/0272989X8300300403
    1. Janssen J, Limnios N. Semi-Markov Models and Applications. Springer. 1999. (Kluwer Academic Publishers).
    1. Jackson CH. Multi-State Models for Panel Data: The msm Package for R. J Stat Softw [Internet]. 2011.38(8):1–28 [cited March 2nd 2022] Available from: .
    1. Efron B. Better Bootstrap Confidence Intervals. J Am Stat Assoc. 1987;82(397):171–85.
    1. DiCiccio T, Efron B. Bootstrap Confidence Intervals. Statiscal Sci. 1996;11(3):189–212.
    1. Davison A, Hinkley DV. Confidence Intervals. In: Bootstrap Methods and their Application. Cambridge University Press. 1997. p. 191–255. (Cambridge Series in Statistical and Probabilistic Mathematics).
    1. Schwebel C, Lucet J-C, 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. doi: 10.1097/CCM.0b013e31822f0604
    1. 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. doi: 10.1086/502459
    1. 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. doi: 10.1016/j.ajic.2010.11.008
    1. Maunoury F, Motrunich A, Palka-Santini M, Bernatchez SF, Ruckly S, Timsit J-F. Cost-Effectiveness Analysis of a Transparent Antimicrobial Dressing for Managing Central Venous and Arterial Catheters in Intensive Care Units. Ricci Z, éditeur. PLOS ONE. 2015;10(6):e0130439. doi: 10.1371/journal.pone.0130439
    1. Van Loon FH, Leggett T, Bouwman AR, Dierick-van Daele AT. Cost-utilization of peripheral intravenous cannulation in hospitalized adults: An observational study. J Vasc Access. 2020;21(5):687–93. doi: 10.1177/1129729820901653
    1. Tuffaha HW, Marsh N, Byrnes J, Gavin N, Webster J, Cooke M, et al.. Cost of vascular access devices in public hospitals in Queensland. Aust Health Rev. 2018;43(5):511–5.
    1. Steere L, Ficara C, Davis M, Moureau N. Reaching One Peripheral Intravenous Catheter (PIVC) Per Patient Visit With Lean Multimodal Strategy: the PIV5RightsTM Bundle. J Assoc Vasc Access. 2019;24(3):31–43.
    1. Liu C, Chen L, Kong D, Lyu F, Luan L, Yang L. Incidence, risk factors and medical cost of peripheral intravenous catheter-related complications in hospitalised adult patients. J Vasc Access. 2020;1–10. doi: 10.1177/1129729820978124

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