Baker Hannah, Avey Brooke, Overbeck Rethmeier Line, Mealing Stuart, Lynge Buchter Marie, Averbeck Márcio Augusto, Thiruchelvam Nikesh
York Health Economics Consortium, York, UK.
Coloplast A/S, Humlebaek, Denmark.
Curr Med Res Opin. 2023 Feb;39(2):319-328. doi: 10.1080/03007995.2022.2151734. Epub 2022 Dec 7.
To estimate the cost-effectiveness of single-use hydrophilic-coated intermittent catheters (HCICs) versus single-use uncoated intermittent catheters (UICs) for urinary catheterization.
The evaluation took a UK national health service (NHS) perspective. The population of interest were people using intermittent catheters, with either a spinal cord injury or multiple sclerosis. A Markov model was developed that estimated costs and clinical evidence over the lifetime of a hypothetical cohort and applied health-related qualityoflife estimates. Model inputs were sourced from published evidence, including a network meta-analysis to inform the treatment effect (reduction in catheter-associated urinary tract infections [CAUTIs]), and were supported by expert opinion. The model outputs included per-patient lifetime costs, quality-adjusted life years (QALYs), and the incremental cost effectiveness ratio (ICER). Event counts were also produced.
Using HCICs instead of UICs could prevent seven CAUTI events per patient over a lifetime horizon (1.8 requiring secondary care). Overall, lifetime use of HCICs is £3,183 more expensive than use of UICs per patient. However, for these additional costs, 0.55 QALYs are gained. The ICER is £5,755 per additional QALY gained. Key drivers of the model results were identified and subject to sensitivity analyses. The results were found to be robust to parameter uncertainty.
HCICs are likely to be a cost-effective alternative to UICs, a result driven by substantial reductions in the number of CAUTIs. Their adoption across clinical practice could avoid a substantial number of infections, freeing up resources in the NHS and reducing antibiotic use in urinary catheter users.
评估一次性使用的亲水涂层间歇性导尿管（HCIC）与一次性使用的无涂层间歇性导尿管（UIC）用于导尿的成本效益。
评估从英国国家医疗服务体系（NHS）的角度进行。目标人群为使用间歇性导尿管的脊髓损伤或多发性硬化患者。构建了一个马尔可夫模型，该模型估计了假设队列一生中的成本和临床证据，并应用了与健康相关的生活质量估计值。模型输入数据来源于已发表的证据，包括一项网络荟萃分析以了解治疗效果（降低导尿管相关尿路感染[CAUTIs]），并得到了专家意见的支持。模型输出包括每位患者的终身成本、质量调整生命年（QALYs）和增量成本效益比（ICER）。还得出了事件计数。
在一生的时间范围内，使用HCIC而非UIC可使每位患者预防7次CAUTI事件（1.8次需要二级护理）。总体而言，每位患者终身使用HCIC比使用UIC贵3183英镑。然而，对于这些额外成本，可获得0.55个QALYs。获得每个额外QALY的ICER为5755英镑。确定了模型结果的关键驱动因素并进行了敏感性分析。结果表明对参数不确定性具有稳健性。
HCIC可能是UIC具有成本效益的替代方案，这一结果是由CAUTIs数量的大幅减少所驱动的。在临床实践中采用HCIC可避免大量感染，释放NHS的资源并减少导尿患者的抗生素使用。
