A cost-effectiveness analysis of long-term intermittent catheterisation with hydrophilic and uncoated catheters

Abstract

Study design: Cost-effectiveness analysis Objective: To establish a model to investigate the cost effectiveness for people with spinal cord injury (SCI), from a lifetime perspective, for the usage of two different single-use catheter designs: hydrophilic-coated (HC) and uncoated (UC). The model includes the long-term sequelae of impaired renal function and urinary tract infection (UTI). Setting: Analysis based on a UK perspective. Methods: A probabilistic Markov decision model was constructed, to compare lifetime costs and quality-adjusted life years, taking renal and UTI health states into consideration, as well as other catheter-related events. UTI event rates for the primary data set were based on data from hospital settings to ensure controlled and accurate reporting. A sensitivity analysis was applied to evaluate best-and worst-case scenarios. Results: The model predicts that a 36-year-old SCI patient with chronic urinary retention will live an additional 1.4 years if using HC catheters compared with UC catheters, at an incremental cost of £2100. Moreover, the lifetime number of UTI events will be reduced by 16%. All best-and worst-case estimates were within the UK threshold of being cost effective. Conclusion: The use of HC catheters for intermittent catheterisation in SCI patients is highly cost effective. The outcome is consistent irrespective of whether UTI data are collected in hospital or community settings.

Healthcare resource consumption for intermittent urinary catheterisation: cost-effectiveness of hydrophilic catheters and budget impact analyses

“…The studies by Cardenas et al 20 21 and Sarica et al 22 focused on SCI patients and reported data useful for the analysis. Data reported by Clark et al 4 derived from an internal report of the study conducted by De Ridder et al 23 were also included.…”

“…Table 1 reports UTI rates according to the methods presented in Clark et al ,4 distinguishing the following settings: hospital period, community setting and combined scenario (hospital and community settings).…”

“…While there is a lack of strong evidence demonstrating the effectiveness of any particular catheter design, technique or strategy,2 the use of different kinds of catheters in the community may have different economic consequences. To the best of our knowledge, two cost-effectiveness studies3 4 have compared lifetime quality-adjusted life years (QALYs) and costs of different types of catheter from the UK perspective. Although both studies focused on the management of urinary tract infections (UTIs), the first3 based its analysis on the annual probability of experiencing at least one UTI for the different catheters considered (without taking into account the mean number of UTIs experienced in the same time by the patients' cohort) and their short-term consequences.…”

“…Although both studies focused on the management of urinary tract infections (UTIs), the first3 based its analysis on the annual probability of experiencing at least one UTI for the different catheters considered (without taking into account the mean number of UTIs experienced in the same time by the patients' cohort) and their short-term consequences. The second study4 focused on the average UTI rate per patient and month for hydrophilic coated and uncoated catheters and considered long-term sequelae such as kidney impairment. Considering a lifetime horizon, the study by Clark et al 4 showed that hydrophilic coated catheters are cost-effective when compared to uncoated catheters.…”

“…The second study4 focused on the average UTI rate per patient and month for hydrophilic coated and uncoated catheters and considered long-term sequelae such as kidney impairment. Considering a lifetime horizon, the study by Clark et al 4 showed that hydrophilic coated catheters are cost-effective when compared to uncoated catheters. Conversely, the study by Bermingham et al 3 reported that the reuse and cleansing of uncoated catheters is the most cost-effective alternative in comparison to all other catheter types.…”