Cost-effectiveness of strategies preventing late-onset infection in preterm infants

Alessandro Grosso, Rita Isabel Neves de Faria, Laura Bojke, Chloe Donohue, Caroline Isabel Fraser, Katie L Harron, Sam J Oddie, Ruth Gilbert, Alessandro Grosso, Rita Isabel Neves de Faria, Laura Bojke, Chloe Donohue, Caroline Isabel Fraser, Katie L Harron, Sam J Oddie, Ruth Gilbert

Abstract

Objective: Developing a model to analyse the cost-effectiveness of interventions preventing late-onset infection (LOI) in preterm infants and applying it to the evaluation of anti-microbial impregnated peripherally inserted central catheters (AM-PICCs) compared with standard PICCs (S-PICCs).

Design: Model-based cost-effectiveness analysis, using data from the Preventing infection using Antimicrobial Impregnated Long Lines (PREVAIL) randomised controlled trial linked to routine healthcare data, supplemented with published literature. The model assumes that LOI increases the risk of neurodevelopmental impairment (NDI).

Setting: Neonatal intensive care units in the UK National Health Service (NHS).

Patients: Infants born ≤32 weeks gestational age, requiring a 1 French gauge PICC.

Interventions: AM-PICC and S-PICC.

Main outcome measures: Life expectancy, quality-adjusted life years (QALYs) and healthcare costs over the infants' expected lifetime.

Results: Severe NDI reduces life expectancy by 14.79 (95% CI 4.43 to 26.68; undiscounted) years, 10.63 (95% CI 7.74 to 14.02; discounted) QALYs and costs £19 057 (95% CI £14 197; £24697; discounted) to the NHS. If LOI causes NDI, the maximum acquisition price of an intervention reducing LOI risk by 5% is £120. AM-PICCs increase costs (£54.85 (95% CI £25.95 to £89.12)) but have negligible impact on health outcomes (-0.01 (95% CI -0.09 to 0.04) QALYs), compared with S-PICCs. The NHS can invest up to £2.4 million in research to confirm that AM-PICCs are not cost-effective.

Conclusions: The model quantifies health losses and additional healthcare costs caused by NDI and LOI during neonatal care. Given these consequences, interventions preventing LOI, even by a small extent, can be cost-effective. AM-PICCs, being less effective and more costly than S-PICC, are not likely to be cost-effective.

Trial registration number: NCT03260517.

Keywords: NNRD; cost-effectiveness; late-onset infection; neurodevelopment; prematurity.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
Model diagram. GA, gestational age; NDI, neurodevelopmental impairment; PICC, peripherally inserted central catheter.
Figure 2
Figure 2
Costs and health outcomes by NDI levels between age 2 and the infants’ expected lifetime. The graph shows NHS costs and health outcomes results obtained by running the long-term component of the model for each NDI level assuming that all infants in the cohort were assessed with the same level of impairment at two years of age. NDI, neurodevelopmental impairment; NHS, National Health Service; QALYs, quality-adjusted life years.
Figure 3
Figure 3
Maximum price by effectiveness level for a new hypothetical intervention. The graph represents, for each level of effectiveness, represented by the relative risk of LOI, the maximum price that could would still make such a new hypothetical intervention cost-effective, at a cost-effectiveness threshold of £20 000/QALY. GA, gestational age; QALY, quality-adjusted life year.

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