Cost-effectiveness analysis of a transparent antimicrobial dressing for managing central venous and arterial catheters in intensive care units

Abstract

Objective: To model the cost-effectiveness impact of routine use of an antimicrobial chlorhexidine gluconatecontaining 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 costeffective than the reference dressing. Copyright: