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

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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).

Related collections

Most cited references 23

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Guidelines for the prevention of intravascular catheter-related infections.

Naomi P O'Grady, Mary Alexander, Lillian Burns … (2011)

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Markov models in medical decision making: a practical guide.

F. Sonnenberg, J Beck (2015)

Markov models are useful when a decision problem involves risk that is continuous over time, when the timing of events is important, and when important events may happen more than once. Representing such clinical settings with conventional decision trees is difficult and may require unrealistic simplifying assumptions. Markov models assume that a patient is always in one of a finite number of discrete health states, called Markov states. All events are represented as transitions from one state to another. A Markov model may be evaluated by matrix algebra, as a cohort simulation, or as a Monte Carlo simulation. A newer representation of Markov models, the Markov-cycle tree, uses a tree representation of clinical events and may be evaluated either as a cohort simulation or as a Monte Carlo simulation. The ability of the Markov model to represent repetitive events and the time dependence of both probabilities and utilities allows for more accurate representation of clinical settings that involve these issues.

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Is Open Access

Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study

Peter Pronovost, Christine A Goeschel, Elizabeth Colantuoni … (2010)

Objectives To evaluate the extent to which intensive care units participating in the initial Keystone ICU project sustained reductions in rates of catheter related bloodstream infections. Design Collaborative cohort study to implement and evaluate interventions to improve patients’ safety. Setting Intensive care units predominantly in Michigan, USA. Intervention Conceptual model aimed at improving clinicians’ use of five evidence based recommendations to reduce rates of catheter related bloodstream infections rates, with measurement and feedback of infection rates. During the sustainability period, intensive care unit teams were instructed to integrate this intervention into staff orientation, collect monthly data from hospital infection control staff, and report infection rates to appropriate stakeholders. Main outcome measures Quarterly rate of catheter related bloodstream infections per 1000 catheter days during the sustainability period (19-36 months after implementation of the intervention). Results Ninety (87%) of the original 103 intensive care units participated, reporting 1532 intensive care unit months of data and 300 310 catheter days during the sustainability period. The mean and median rates of catheter related bloodstream infection decreased from 7.7 and 2.7 (interquartile range 0.6-4.8) at baseline to 1.3 and 0 (0-2.4) at 16-18 months and to 1.1 and 0 (0.0-1.2) at 34-36 months post-implementation. Multilevel regression analysis showed that incidence rate ratios decreased from 0.68 (95% confidence interval 0.53 to 0.88) at 0-3 months to 0.38 (0.26 to 0.56) at 16-18 months and 0.34 (0.24-0.48) at 34-36 months post-implementation. During the sustainability period, the mean bloodstream infection rate did not significantly change from the initial 18 month post-implementation period (−1%, 95% confidence interval −9% to 7%). Conclusions The reduced rates of catheter related bloodstream infection achieved in the initial 18 month post-implementation period were sustained for an additional 18 months as participating intensive care units integrated the intervention into practice. Broad use of this intervention with achievement of similar results could substantially reduce the morbidity and costs associated with catheter related bloodstream infections.

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Author and article information

Contributors

Zaccaria Ricci: Role: Academic Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 18 June 2015

Publication date Collection: 2015

Volume: 10

Issue: 6

Electronic Location Identifier: e0130439

Affiliations

[1 ]Statesia, Le Mans, France

[2 ]3M Company, Neuss, Germany

[3 ]3M Company, St. Paul, United States of America

[4 ]Grenoble University Hospital, Grenoble, France

[5 ]IAME UMR1137-Team 5 Decision Sciences in Infectious Disease Prevention, Control and Care, Paris Diderot University-Inserm, Sorbonne Paris Cité, Paris, France

[6 ]Paris Diderot University—Bichat University hospital—Medical and Infectious Diseases Intensive care unit, Paris, France

Bambino Gesù Children's Hospital, ITALY

Author notes

Competing Interests: This study was funded by 3M Company, http://solutions.3mdeutschland.de/wps/portal/3M/de_DE/EU2/Country/. MPS and SFB are employees of 3M Company and had a role in preparation of the manuscript. 3M Tegaderm CHG is a product marketed by 3M Company. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Conceived and designed the experiments: FM AM. Performed the experiments: FM AM. Analyzed the data: FM AM. Contributed reagents/materials/analysis tools: FM AM SR JFT. Wrote the paper: FM AM. Contributed to reviewing the manuscript, as well as to the presentation of the figures and tables: MPS. Critically reviewed the draft of the manuscript for contents and clarity and for data interpretation, contributed to manuscript reviewing and editing, as well as to the presentation of the figures and tables, and the discussion: SFB.

* E-mail: franck.maunoury@ 123456statesia.com

Article

Publisher ID: PONE-D-14-57780

DOI: 10.1371/journal.pone.0130439

PMC ID: 4472776

PubMed ID: 26086783

SO-VID: 24380825-0ed5-4ce9-8818-442c190f68bf

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Date received : 24 December 2014

Date accepted : 20 May 2015

Page count

Figures: 3, Tables: 4, Pages: 14

Funding

This study was funded by 3M Company FM, http://solutions.3mdeutschland.de/wps/portal/3M/de_DE/EU2/Country/. MPS and SFB had a role in preparation of the manuscript.

Custom metadata

Data Availability All relevant data are within the paper and its Supporting Information files (Supporting Information filenames: S1 and S2 Tables).

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

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Abstract

Objective

Design

Patients

Intervention

Results

Conclusions

Trial Registration

Related collections

PLOS Climate

Most cited references 23

Guidelines for the prevention of intravascular catheter-related infections.

Markov models in medical decision making: a practical guide.

Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study

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