Devices and Infection
Which antimicrobial impregnated central venous catheter should we use? Modeling the costs and outcomes of antimicrobial catheter use*,**

https://doi.org/10.1067/mic.2003.35Get rights and content

Abstract

Background: Catheter-related bloodstream infections are costly and associated with substantial morbidity and mortality. Trials suggest that central venous catheters impregnated with minocycline/rifampin, although more expensive, are clinically superior to chlorhexidine/silver sulfadiazine impregnated catheters. It remains unclear whether minocycline/rifampin catheters are cost-effective for all high-risk patients or only those requiring longer-term catheterization. Methods: We developed a series of decision models with patient-level clinical trial data to determine whether minocycline/rifampin catheters are cost-effective for patients requiring various durations of catheterization. We calculated incremental cost-effectiveness ratios for patients catheterized for durations ranging from 1 to 25 days. Results: The data were too sparse to estimate cost-effectiveness for patients catheterized less than 8 days. The probability that minocycline/rifampin catheters were cost-effective compared with chlorhexidine/silver sulfadiazine catheters in patients catheterized for 8 days was 91%. The probability that the minocycline/rifampin catheters in patients catheterized 13 days or longer resulted in cost savings was more than 95%. Conclusions: Our analysis suggests that central venous catheters coated with minocycline/rifampin are cost-effective for patients catheterized for at least 1 week and lead to overall cost savings when patients are catheterized for 2 weeks or longer. Policies for the use of antimicrobial catheters in high-risk patients should reflect patients' expected duration of catheterization. (Am J Infect Control 2003;31:1-8.)

Section snippets

Model

Like the authors of a prior catheter cost-effectiveness study,9 we used decision models to compare the outcomes of patients catheterized with minocycline/rifampin catheters with those of patients catheterized with chlorhexidine/silver sulfadiazine catheters and the associated costs for each group.17, 18 We built 25 models representing patients catheterized for different durations: 1 to 25 days (Fig 1).

. Decision analytic model. (CR-BSI, Catheter-related bloodstream infection.)

We choose externally

Results

Because no cases of CR-BSI occurred among patients randomized to the minocycline/rifampin catheters for the first 7 days of catheterization,13 we were unable to estimate the relative risk of CR-BSI and the cost-effectiveness of the minocycline/rifampin catheters for patients expected to be catheterized less than 8 days.

Among patients expected to be catheterized more than 1 week, the clinical and economic benefits of the minocycline/rifampin catheters increased with the duration of

Discussion

We compared the clinical and economic consequences of the use of central venous catheters coated with minocycline/rifampin versus chlorhexidine/silver sulfadiazine in patients at high risk for CR-BSI by decision analytic techniques. Our analysis demonstrated that the probability of cost-effectiveness and cost-savings depended on the duration patients were expected to be catheterized. Because of limited data, we were unable to evaluate whether the minocycline/rifampin catheters were

Acknowledgements

We thank Rabih Darouiche, MD, for sharing his data; Leonard Mermel, DO, and Thomas M. Hooton, MD, for sharing their clinical expertise; and the Research Foundation for the Prevention of Complications Associated with Health Care for funding the study.

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    *

    Dr Saint was supported by a Career Development Award from the VA Health Services Research and Development Service during the time much of this work was completed.

    **

    Reprint requests: David L. Veenstra, PharmD, PhD, Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Box 357630, Seattle, WA 98195.

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