Rui Wang1, Michele R Hacker1,2,3, Roger Lefevre4,5. 1. Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Kirstein 3, Boston, MA, 02215, USA. 2. Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, 02115, USA. 3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA. 4. Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Kirstein 3, Boston, MA, 02215, USA. rlefevre@bidmc.harvard.edu. 5. Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, 02115, USA. rlefevre@bidmc.harvard.edu.
Abstract
PURPOSE: We evaluate the cost-effectiveness of prophylactic antibiotic use to prevent catheter-associated urinary tract infections. MATERIALS AND METHODS: A decision tree model was used to assess the cost-effectiveness of prophylactic antibiotics in preventing catheter-associated urinary tract infections for patients with a short-term indwelling urinary catheter. The model accounted for incidence of urinary tract infections with and without the use of prophylactic antibiotics, incidence of antibiotic-resistant urinary tract infections, as well as costs associated with diagnosis and treatment of urinary tract infections and antibiotic-resistant urinary tract infections. Costs were calculated from the health care system's perspective. We conducted one-way sensitivity analyses. RESULTS: The base case analysis showed that the use of prophylactic antibiotics is cost-saving in preventing catheter-associated urinary tract infections. The use of prophylactic antibiotics resulted in lower costs and higher quality-adjusted life-years compared with no prophylactic antibiotics. Sensitivity analyses showed that the optimal strategy changes to no prophylactic antibiotics when the incidence of urinary tract infections after prophylactic antibiotics exceeds 22% or the incidence of developing urinary tract infections without prophylactic antibiotics is less than 12%. Varying the costs of prophylactic antibiotics, urinary tract infection treatment, or antibiotic-resistant urinary tract infection treatment within a reasonable range did not change the optimal strategy. CONCLUSIONS: Prophylactic antibiotic use to prevent catheter-associated urinary tract infections is cost-effective under most conditions. These results were sensitive to the likelihood of developing catheter-associated urinary tract infections with and without prophylactic antibiotics. Our results are limited to the cost-effectiveness perspective on this clinical practice.
PURPOSE: We evaluate the cost-effectiveness of prophylactic antibiotic use to prevent catheter-associated urinary tract infections. MATERIALS AND METHODS: A decision tree model was used to assess the cost-effectiveness of prophylactic antibiotics in preventing catheter-associated urinary tract infections for patients with a short-term indwelling urinary catheter. The model accounted for incidence of urinary tract infections with and without the use of prophylactic antibiotics, incidence of antibiotic-resistant urinary tract infections, as well as costs associated with diagnosis and treatment of urinary tract infections and antibiotic-resistant urinary tract infections. Costs were calculated from the health care system's perspective. We conducted one-way sensitivity analyses. RESULTS: The base case analysis showed that the use of prophylactic antibiotics is cost-saving in preventing catheter-associated urinary tract infections. The use of prophylactic antibiotics resulted in lower costs and higher quality-adjusted life-years compared with no prophylactic antibiotics. Sensitivity analyses showed that the optimal strategy changes to no prophylactic antibiotics when the incidence of urinary tract infections after prophylactic antibiotics exceeds 22% or the incidence of developing urinary tract infections without prophylactic antibiotics is less than 12%. Varying the costs of prophylactic antibiotics, urinary tract infection treatment, or antibiotic-resistant urinary tract infection treatment within a reasonable range did not change the optimal strategy. CONCLUSIONS: Prophylactic antibiotic use to prevent catheter-associated urinary tract infections is cost-effective under most conditions. These results were sensitive to the likelihood of developing catheter-associated urinary tract infections with and without prophylactic antibiotics. Our results are limited to the cost-effectiveness perspective on this clinical practice.
Authors: Bruce Y Lee; Rachel R Bailey; Kenneth J Smith; Robert R Muder; Elsa S Strotmeyer; G Jonathan Lewis; Paul J Ufberg; Yeohan Song; Lee H Harrison Journal: Infect Control Hosp Epidemiol Date: 2010-06 Impact factor: 3.254
Authors: Frank A Sonnenberg; Ronald T Burkman; C Greg Hagerty; Leon Speroff; Theodore Speroff Journal: Contraception Date: 2004-06 Impact factor: 3.375