IDEAS home Printed from https://ideas.repec.org/p/hal/journl/hal-01802878.html
   My bibliography  Save this paper

Cost-effectiveness analysis of chlorhexidine-alcohol versus povidone iodine-alcohol solution in the prevention of intravascular-catheter-related bloodstream infections in France

Author

Listed:
  • Franck Maunoury

    (Statésia - Statésia. Des données & des décisions)

  • Christian Farinetto

    (Statésia - Statésia. Des données & des décisions)

  • Stéphane Ruckly

    (ICUREsearch)

  • Jérémy Guenezan

    (Service des urgences [CHU Poitiers] = Emergency Department (ER) [Poitiers University Hospital] - CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital)

  • Jean-Christophe Lucet

    (AP-HP - Hôpital Bichat - Claude Bernard [Paris] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP))

  • Alain Lepape

    (CHLS - Centre Hospitalier Lyon Sud [CHU - HCL] - HCL - Hospices Civils de Lyon)

  • Julien Pascal

    (CHU Clermont-Ferrand)

  • Bertrand Souweine

    (CHU Clermont-Ferrand)

  • Olivier Mimoz

    (PHAR [Poitiers] - Pharmacologie des anti-infectieux - UP - Université de Poitiers = University of Poitiers - INSERM - Institut National de la Santé et de la Recherche Médicale, CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital)

  • Jean-François Timsit

    (AP-HP - Hôpital Bichat - Claude Bernard [Paris] - AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP))

Abstract

Objective: To perform a cost-effectiveness analysis of skin antiseptic solutions (chlorhexidine-alcohol (CHG) versus povidone iodine-alcohol solution (PVI)) for the prevention of intravascular-catheter-related bloodstream infections (CRBSI) in intensive care unit (ICU) in France based on an open-label, multicentre, randomised, controlled trial (CLEAN). Design: A 100-day time semi-markovian model was performed to be fitted to longitudinal individual patient data from CLEAN database. This model includes eight health states and probabilistic sensitivity analyses on cost and effectiveness were performed. Costs of intensive care unit stay are based on a French multicentre study and the cost-effectiveness criterion is the cost per patient with catheter-related bloodstream infection avoided.Patients:2,349 patients (age≥18 years) were analyzed to compare the 1-time CHG group (CHG-T1, 588 patients), the 4-time CHG group (CHG-T4, 580 patients), the 1-time PVI group (PVI-T1, 587 patients), and the 4-time PVI group (PVI-T4, 594 patients). Intervention:2% chlorhexidine-70% isopropyl alcohol (chlorhexidine-alcohol) compared to 5% povidone iodine-69% ethanol (povidone iodine-alcohol). Results: The mean cost per alive, discharged or dead patient was of €23,798 (95% confidence interval: €20,584; €34,331), €21,822 (€18,635; €29,701), €24,874 (€21,011; €31,678), and €24,201 (€20,507; €29,136) for CHG-T1, CHG-T4, PVI-T1, and PVI-T4, respectively. The mean number of patients with CRBSI per 1000 patients was of 3.49 (0.42; 12.57), 6.82 (1.86; 17.38), 26.04 (14.64; 42.58), and 23.05 (12.32; 39.09) for CHG-T1, CHG-T4, PVI-T1, and PVI-T4, respectively. In comparison to the 1-time PVI solution, the 1-time CHG solution avoids 22.55 CRBSI /1,000 patients, and saves €1,076 per patient. This saving is not statistically significant at a 0.05 level because of the overlap of 95% confidence intervals for mean costs per patient in each group. Conversely, the difference in effectiveness between the CHG-T1 solution and the PVI-T1 solution is statistically significant. Conclusions: The CHG-T1 solution is more effective at the same cost than the PVI-T1 solution. CHG-T1, CHG-T4 and PVI-T4 solutions are statistically comparable for cost and effectiveness.This study is based on the data from the RCT from 11 French intensive care units registered with www.clinicaltrials.gov (NCT01629550).

Suggested Citation

  • Franck Maunoury & Christian Farinetto & Stéphane Ruckly & Jérémy 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," Post-Print hal-01802878, HAL.
    • Handle: RePEc:hal:journl:hal-01802878
    DOI: 10.1371/journal.pone.0197747
    Note: View the original document on HAL open archive server: https://hal.science/hal-01802878v1
    as

    Download full text from publisher

    File URL: https://hal.science/hal-01802878v1/document
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0197747?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. 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.
    2. Jackson, Christopher, 2011. "Multi-State Models for Panel Data: The msm Package for R," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 38(i08).
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    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.
    2. Qiu, Qinjing & Kawai, Reiichiro, 2022. "A decoupling principle for Markov-modulated chains," Statistics & Probability Letters, Elsevier, vol. 182(C).
    3. Vernon T. Farewell & Li Su & Christopher Jackson, 2019. "Partially hidden multi-state modelling of a prolonged disease state defined by a composite outcome," Lifetime Data Analysis: An International Journal Devoted to Statistical Methods and Applications for Time-to-Event Data, Springer, vol. 25(4), pages 696-711, October.
    4. Gaffney, Edward & McCann, Fergal, 2019. "The cyclicality in SICR: mortgage modelling under IFRS 9," ESRB Working Paper Series 92, European Systemic Risk Board.
    5. Sek-yum Ngai, Steven & Cheung, Chau-kiu & Ng, Yuen-hang & Joo Lee, Bong & Dupéré, Véronique & Wang, Miao & Zhou, Qiushi & Chen, Chen & Li, Yunjun & Wong, Laing-ming & Yu, Elly Ngai-hin, 2025. "Unraveling the school-to-work transition of non-engaged youth: A continuous-time Markov chain analysis," Children and Youth Services Review, Elsevier, vol. 172(C).
    6. Biagini, Francesca & Groll, Andreas & Widenmann, Jan, 2013. "Intensity-based premium evaluation for unemployment insurance products," Insurance: Mathematics and Economics, Elsevier, vol. 53(1), pages 302-316.
    7. Sharples, Linda D., 2018. "The role of statistics in the era of big data: Electronic health records for healthcare research," Statistics & Probability Letters, Elsevier, vol. 136(C), pages 105-110.
    8. Alex Bottle & Chiara Maria Ventura & Kumar Dharmarajan & Paul Aylin & Francesca Ieva & Anna Maria Paganoni, 2018. "Regional variation in hospitalisation and mortality in heart failure: comparison of England and Lombardy using multistate modelling," Health Care Management Science, Springer, vol. 21(2), pages 292-304, June.
    9. Wildhaber, Mark L. & Albers, Janice L. & Green, Nicholas S. & Moran, Edward H., 2017. "A fully-stochasticized, age-structured population model for population viability analysis of fish: Lower Missouri River endangered pallid sturgeon example," Ecological Modelling, Elsevier, vol. 359(C), pages 434-448.
    10. Budhi Surya, 2021. "A new class of conditional Markov jump processes with regime switching and path dependence: properties and maximum likelihood estimation," Papers 2107.07026, arXiv.org.
    11. Tsiropoulos, Vasilis, 2018. "A Vulnerability Analysis for Mortgaged Irish Households," Financial Stability Notes 02-18, Central Bank of Ireland.
    12. João Costa Freitas & Alberto Adrego Pinto & Óscar Felgueiras, 2024. "Game Theory for Predicting Stocks’ Closing Prices," Mathematics, MDPI, vol. 12(17), pages 1-49, August.
    13. Sarrias, Mauricio, 2021. "A two recursive equation model to correct for endogeneity in latent class binary probit models," Journal of choice modelling, Elsevier, vol. 40(C).
    14. Emanuel Krebs & Jeong E. Min & Elizabeth Evans & Libo Li & Lei Liu & David Huang & Darren Urada & Thomas Kerr & Yih-Ing Hser & Bohdan Nosyk, 2017. "Estimating State Transitions for Opioid Use Disorders," Medical Decision Making, , vol. 37(5), pages 483-497, July.
    15. Guglielmo D'Amico & Stefania Scocchera & Loriano Storchi, 2021. "Randentropy: a software to measure inequality in random systems," Papers 2103.09107, arXiv.org.
    16. Wood, Kevin A. & Hilton, Geoff M. & Newth, Julia L. & Rees, Eileen C., 2019. "Seasonal variation in energy gain explains patterns of resource use by avian herbivores in an agricultural landscape: Insights from a mechanistic model," Ecological Modelling, Elsevier, vol. 409(C), pages 1-1.
    17. Sy-Miin Chow & Guangjian Zhang, 2013. "Nonlinear Regime-Switching State-Space (RSSS) Models," Psychometrika, Springer;The Psychometric Society, vol. 78(4), pages 740-768, October.
    18. Cristian Preda & Quentin Grimonprez & Vincent Vandewalle, 2021. "Categorical Functional Data Analysis. The cfda R Package," Mathematics, MDPI, vol. 9(23), pages 1-31, November.
    19. Michael Crowther & Paul Lambert, 2016. "Multistate survival analysis in Stata," United Kingdom Stata Users' Group Meetings 2016 02, Stata Users Group.
    20. Pauhofová, Iveta & Želinský, Tomáš, 2017. "On the Regional Convergence of Income at District Level in Slovakia," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 65(10), pages 918-934.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:hal:journl:hal-01802878. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: CCSD (email available below). General contact details of provider: https://hal.archives-ouvertes.fr/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.