Cost-effectiveness analysis of hydrophilic-coated catheters in long-term intermittent catheter users in the UK

Abstract

Objective

To estimate the cost-effectiveness of single-use hydrophilic-coated intermittent catheters (HCICs) versus single-use uncoated intermittent catheters (UICs) for urinary catheterization.

Methods

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 quality-of-life 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.

Results

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.

Conclusion

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.

PLAIN LANGUAGE SUMMARY

A new economic model was developed from a United Kingdom National Health Service perspective, to explore whether hydrophilic-coated intermittent catheters would be “worth” introducing for intermittent catheter users with either a spinal cord injury or multiple sclerosis. More specifically, costs were analyzed alongside clinical evidence and health-related quality-of-life data to investigate whether hydrophilic-coated intermittent catheters would offer a notable health benefit when compared with uncoated intermittent catheters for the assessed population, whilst keeping costs to the National Health Service sufficiently low. Model inputs were sourced from published evidence where possible, and experts were consulted otherwise. The results showed that, whilst lifetime use of hydrophilic-coated intermittent catheters is £3,183 more expensive than use of uncoated intermittent catheters per patient, the health benefit with hydrophilic-coated intermittent catheters offsets these costs, by definition a cost-effective result. This means that hydrophilic-coated intermittent catheters are likely to be a cost-effective alternative to uncoated intermittent catheters. Their adoption across clinical practice could avoid a substantial number of infections, thereby freeing up healthcare resources in the National Health Service and reducing antibiotic use in urinary catheter users.

Keywords:

• Economic evaluation
• urinary tract infection
• catheter
• neurogenic bladder
• spinal cord

Transparency

Declaration of funding

Coloplast sponsored this economic analysis and contributed to the development and review of this article.

Declaration of financial/other relationships

Hannah Baker, Brooke Avey and Stuart Mealing are employees of York Health Economics Consortium, who were commissioned by Coloplast to provide consultancy, develop the economic model, and draft the manuscript. Line Overbeck Rethmeier and Marie Lynge Buchter are employees of Coloplast. Marcio Averbeck is a paid advisor to Coloplast, Medtronic, Boston Scientific, and GSK. Nikesh Thiruchelvam is a paid advisor to Coloplast. He also receives teaching fees from Boston Scientific. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors contributed to the model design, parameter elicitation and validation of results. Hannah Baker, Brooke Avey and Stuart Mealing were responsible for model construction. All authors contributed to the manuscript draft.

Acknowledgements

None.