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.

Figures

Fig 1. Structure of the Markov Model…
Fig 1. Structure of the Markov Model showing the possible transition between health states from one Markov cycle to the next cycle.
The costs per patient for each health state were calculated in both CHG and No-CHG dressing as respectively: State 1: €1,270 and €1,266; State 2: €1,364 and €1,361; State 3: €13,661 and €13,658; State 4: €13,756 and €13,752; State 5: €1,388 and €1,385; State 6: €1,266 and €1,266; State 7: €0 for both groups; State 8: €0 for both groups; CHG: chlorhexidine gluconate; CRBSI: catheter-related bloodstream infection; CT: catheter.
Fig 2. Tornado diagram for the One-way…
Fig 2. Tornado diagram for the One-way Sensitivity Analysis.
This diagram illustrates the impact of the variation in some parameters of the model on the cost difference between the strategies. The base case is average cost difference (€+141) between the two dressing strategies for the parameter’s values indicated on the “y” axis. The tested range for each parameter is indicated by the arrows. The main driver parameter for cost difference is the Extra LOS associated to CRBSI. ICU: Intensive Care Unit; CRBSI: Catheter-related bloodstream infection; CHG: Chlorhexidine Gluconate; LOS: Length of Stay.
Fig 3. Cost-effectiveness results for the probabilistic…
Fig 3. Cost-effectiveness results for the probabilistic sensitivity analysis.
The analysis uses 1,000 non-homogeneous Markov-Chain Monte Carlo simulations of 1,000 patients for each dressing strategy. The x axis represents the difference in effectiveness (number of CRBSI events in CHG versus non CHG dressing) and the y axis represents the difference in cost (mean cost per patient with CHG versus non CHG dressing) in €2013. The (0,0)-point indicates the reference dressing strategy (Non-CHG group). Each point in the graph represents the Incremental Cost-Effectiveness Ratio (ICER) of CHG-dressing strategy versus reference dressing. All but three points are at the left side of the graph, showing that CHG dressing strategy was 99.7% more effective than the comparator at the same costs per patient. The squared point in the center of the cloud represents the average CE ratio of all 1,000 simulations. CHG: chlorhexidine gluconate; CRBSI: catheter-related bloodstream infection.

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