Ridyard Colin H, Plumpton Catrin O, Gilbert Ruth E, Hughes Dyfrig A
Centre for Health Economics and Medicines Evaluation, Bangor Institute for Health and Medical Research, Bangor UniversityBangor, United Kingdom.
UCL Institute of Child Health, University College LondonLondon, United Kingdom.
Front Pharmacol. 2017 Sep 19;8:644. doi: 10.3389/fphar.2017.00644. eCollection 2017.
Antibiotic-impregnated central venous catheters (CVCs) reduce the risk of bloodstream infections (BSIs) in patients treated in pediatric intensive care units (PICUs). However, it is unclear if they are cost-effective from the perspective of the National Health Service (NHS) in the UK. Economic evaluation alongside the CATCH trial (ISRCTN34884569) to estimate the incremental cost effectiveness ratio (ICER) of antibiotic-impregnated (rifampicin and minocycline), heparin-bonded and standard polyurethane CVCs. The 6-month costs of CVCs and hospital admissions and visits were determined from administrative hospital data and case report forms. BSIs were detected in 3.59% (18/502) of patients randomized to standard, 1.44% (7/486) to antibiotic and 3.42% (17/497) to heparin CVCs. Lengths of hospital stay did not differ between intervention groups. Total mean costs (95% confidence interval) were: £45,663 (£41,647-£50,009) for antibiotic, £42,065 (£38,322-£46,110) for heparin, and £44,503 (£40,619-£48,666) for standard CVCs. As heparin CVCs were not clinically effective at reducing BSI rate compared to standard CVCs, they were considered not to be cost-effective. The ICER for antibiotic vs. standard CVCs, of £54,057 per BSI avoided, was sensitive to the analytical time horizon. Substituting standard CVCs for antibiotic CVCs in PICUs will result in reduced occurrence of BSI but there is uncertainty as to whether this would be a cost-effective strategy for the NHS.
抗生素浸渍中心静脉导管（CVC）可降低儿科重症监护病房（PICU）患者发生血流感染（BSI）的风险。然而，从英国国家医疗服务体系（NHS）的角度来看，其成本效益尚不清楚。开展了一项与CATCH试验（ISRCTN34884569）并行的经济评估，以估计抗生素浸渍（利福平和米诺环素）、肝素涂层和标准聚氨酯CVC的增量成本效益比（ICER）。通过医院管理数据和病例报告表确定了CVC使用6个月的成本以及住院和就诊费用。随机分配至标准CVC组的患者中，3.59%（18/502）发生了BSI；抗生素CVC组为1.44%（7/486）；肝素CVC组为3.42%（17/497）。各干预组的住院时间无差异。平均总成本（95%置信区间）分别为：抗生素CVC组45,663英镑（41,647 - 50,009英镑），肝素CVC组42,065英镑（38,322 - 46,110英镑），标准CVC组44,503英镑（40,619 - 48,666英镑）。由于与标准CVC相比，肝素CVC在降低BSI发生率方面无临床效果，因此认为其不具有成本效益。抗生素CVC与标准CVC相比，每避免一例BSI的ICER为54,057英镑，该结果对分析时间范围敏感。在PICU中用标准CVC替代抗生素CVC将减少BSI的发生，但对于NHS而言，这是否是一种具有成本效益的策略尚不确定。
