Centre for Health Economics, University of York, York, UK
Centre for Health Economics, University of York, York, UK.
Arch Dis Child. 2020 May;105(5):452-457. doi: 10.1136/archdischild-2019-317640. Epub 2019 Dec 13.
Developing a model to analyse the cost-effectiveness of interventions preventing late-onset infection (LOI) in preterm infants and applying it to the evaluation of anti-microbial impregnated peripherally inserted central catheters (AM-PICCs) compared with standard PICCs (S-PICCs).
Model-based cost-effectiveness analysis, using data from the Preventing infection using Antimicrobial Impregnated Long Lines (PREVAIL) randomised controlled trial linked to routine healthcare data, supplemented with published literature. The model assumes that LOI increases the risk of neurodevelopmental impairment (NDI).
Neonatal intensive care units in the UK National Health Service (NHS).
Infants born ≤32 weeks gestational age, requiring a 1 French gauge PICC.
AM-PICC and S-PICC.
Life expectancy, quality-adjusted life years (QALYs) and healthcare costs over the infants' expected lifetime.
Severe NDI reduces life expectancy by 14.79 (95% CI 4.43 to 26.68; undiscounted) years, 10.63 (95% CI 7.74 to 14.02; discounted) QALYs and costs £19 057 (95% CI £14 197; £24697; discounted) to the NHS. If LOI causes NDI, the maximum acquisition price of an intervention reducing LOI risk by 5% is £120. AM-PICCs increase costs (£54.85 (95% CI £25.95 to £89.12)) but have negligible impact on health outcomes (-0.01 (95% CI -0.09 to 0.04) QALYs), compared with S-PICCs. The NHS can invest up to £2.4 million in research to confirm that AM-PICCs are not cost-effective.
The model quantifies health losses and additional healthcare costs caused by NDI and LOI during neonatal care. Given these consequences, interventions preventing LOI, even by a small extent, can be cost-effective. AM-PICCs, being less effective and more costly than S-PICC, are not likely to be cost-effective.
NCT03260517.
建立一种模型，分析预防早产儿迟发性感染（LOI）的干预措施的成本效益，并将其应用于抗微生物浸渍外周插入中心导管（AM-PICC）与标准 PICC（S-PICC）的评估。
基于成本效益的模型分析，使用来自预防感染使用抗菌浸渍长管（PREVAIL）随机对照试验的数据，该试验与常规医疗数据相关联，并辅以已发表的文献。该模型假设 LOI 会增加神经发育障碍（NDI）的风险。
英国国家医疗服务体系（NHS）的新生儿重症监护病房。
胎龄≤32 周、需要 1 法国规格 PICC 的婴儿。
AM-PICC 和 S-PICC。
婴儿预期寿命、质量调整生命年（QALYs）和一生中的医疗保健成本。
严重的 NDI 会使预期寿命缩短 14.79 岁（95%CI 4.43 岁至 26.68 岁；未贴现），10.63 岁（95%CI 7.74 岁至 14.02 岁；贴现），NHS 的 QALYs 和成本为 19057 英镑（95%CI 14197 英镑；24697 英镑；贴现）。如果 LOI 导致 NDI，则降低 LOI 风险 5%的干预措施的最高购置价格为 120 英镑。与 S-PICC 相比，AM-PICC 增加了成本（54.85 英镑（95%CI 25.95 英镑至 89.12 英镑）），但对健康结果几乎没有影响（0.01 个 QALY（95%CI 0.09 至 0.04））。NHS 可以投资高达 240 万英镑用于研究，以确认 AM-PICC 不具有成本效益。
该模型量化了新生儿护理期间 NDI 和 LOI 造成的健康损失和额外的医疗保健成本。鉴于这些后果，预防 LOI 的干预措施，即使是很小程度的干预，也可能具有成本效益。与 S-PICC 相比，AM-PICC 的效果较差，成本较高，因此不太可能具有成本效益。
NCT03260517。
