Saint S, Veenstra D L, Sullivan S D, Chenoweth C, Fendrick A M
Division of General Medicine, Department of Internal Medicine, University of Michigan, 3116 Taubman Center, Campus Box 0376, Ann Arbor, MI 48109-0376, USA.
Arch Intern Med. 2000 Sep 25;160(17):2670-5. doi: 10.1001/archinte.160.17.2670.
Catheter-associated urinary tract infection (UTI) is associated with increased morbidity, mortality, and costs. A recent meta-analysis concluded that silver alloy catheters reduce the incidence of UTI by 3-fold; however, clinicians must decide whether the efficacy of such catheters is worth the extra per unit cost of $5.30.
To assess the clinical and economic impact of using silver alloy urinary catheters in hospitalized patients.
The decision model, performed from the health care payer's perspective, evaluated a simulated cohort of 1000 hospitalized patients on general medical, surgical, urologic, and intensive care services requiring short-term urethral catheterization (2-10 days). We compared 2 catheterization strategies: silver alloy catheters and standard (noncoated) urinary catheters. Outcomes included the incidence of symptomatic UTI and bacteremia and direct medical costs.
In the base-case analysis, use of silver-coated catheters led to a 47% relative decrease in the incidence of symptomatic UTI from 30 to 16 cases per 1000 patients (number needed to treat = 74) and a 44% relative decrease in the incidence of bacteremia from 4.5 to 2.5 cases per 1000 patients (number needed to treat = 500) compared with standard catheters. Use of silver alloy catheters resulted in estimated cost savings of $4.09 per patient compared with standard catheter use ($20.87 vs $16.78). In a multivariate sensitivity analysis using Monte Carlo simulation, silver-coated catheters provided clinical benefits over standard catheters in all cases and cost savings in 84% of cases.
Using silver alloy catheters in hospitalized patients requiring short-term urinary catheterization reduces the incidence of symptomatic UTI and bacteremia, and is likely to produce cost savings compared with standard catheters.
导尿管相关尿路感染（UTI）与发病率、死亡率增加及成本上升相关。最近一项荟萃分析得出结论，银合金导尿管可将UTI发病率降低3倍；然而，临床医生必须决定此类导尿管的疗效是否值得每单位5.30美元的额外成本。
评估在住院患者中使用银合金导尿管的临床和经济影响。
从医疗保健支付方的角度进行决策模型，评估了1000名需要短期尿道插管（2 - 10天）的普通内科、外科、泌尿科和重症监护服务住院患者的模拟队列。我们比较了两种插管策略：银合金导尿管和标准（无涂层）导尿管。结果包括有症状UTI和菌血症的发病率以及直接医疗成本。
在基础病例分析中，与标准导尿管相比，使用银涂层导尿管使有症状UTI的发病率相对降低47%，从每1000例患者30例降至16例（需治疗人数 = 74），菌血症发病率相对降低44%，从每1000例患者4.5例降至2.5例（需治疗人数 = 500）。与使用标准导尿管相比，使用银合金导尿管估计每位患者可节省成本4.09美元（20.87美元对16.78美元）。在使用蒙特卡罗模拟的多变量敏感性分析中，银涂层导尿管在所有情况下都比标准导尿管提供临床益处，在84%的情况下节省成本。
在需要短期导尿的住院患者中使用银合金导尿管可降低有症状UTI和菌血症的发病率，并且与标准导尿管相比可能节省成本。
