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Cost-Effectiveness Analysis of a Transparent Antimicrobial Dressing for Managing Central Venous and Arterial Catheters in Intensive Care Units

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Listed:
  • 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).

Suggested Citation

  • Franck Maunoury & Anastasiia Motrunich & Maria Palka-Santini & Stéphanie F Bernatchez & Stéphane Ruckly & Jean-François Timsit, 2015. "Cost-Effectiveness Analysis of a Transparent Antimicrobial Dressing for Managing Central Venous and Arterial Catheters in Intensive Care Units," PLOS ONE, Public Library of Science, vol. 10(6), pages 1-14, June.
    • Handle: RePEc:plo:pone00:0130439
    DOI: 10.1371/journal.pone.0130439
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    References listed on IDEAS

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    2. Karl Claxton & John Posnett, 1996. "An economic approach to clinical trial design and research priority‐setting," Health Economics, John Wiley & Sons, Ltd., vol. 5(6), pages 513-524, November.
    3. Karl Claxton & John Posnett, "undated". "An Economic Approach to Clinical Trial Design and Research Priority Setting," Discussion Papers 96/19, Department of Economics, University of York.
    4. Frank A. Sonnenberg & J. Robert Beck, 1993. "Markov Models in Medical Decision Making," Medical Decision Making, , vol. 13(4), pages 322-338, December.
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    1. Franck Maunoury & Christian Farinetto & Stéphane Ruckly & Jeremy Guenezan & Jean-Christophe Lucet & Alain Lepape & Julien Pascal & Bertrand Souweine & Olivier Mimoz & Jean-François Timsit, 2018. "Cost-effectiveness analysis of chlorhexidine-alcohol versus povidone iodine-alcohol solution in the prevention of intravascular-catheter-related bloodstream infections in France," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-16, May.

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