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

Figures & data

Figure 1. Model structure.

Table 1. General model inputs.

Parameter	Base case value	Source
Starting age	47	Average across the two indications: SCI-specific demographics^18. MS-specific demographics^19.
Proportion male	55%
Baseline rate of infections (in uncoated catheter users)	3.27	Weighted average of rates from four studies: [n = 114, annual rate = 5.76]^23, [n = 23, annual rate = 1.68]^24, [n = 61, annual rate = 4.56]^25, [n = 502, annual rate = 2.62]^26.
Relative risk of infection (treatment effect of hydrophilic-coated catheters)	0.84	^27
Standardized mortality ratio (SMR) for SCI	2.07	^21
Standardized mortality ratio (SMR) for MS	2.61	^22
Average cost per hydrophilic-coated catheter (male)	£1.78	^28
Average cost per hydrophilic-coated catheter (female)	£1.66	^28
Average cost per uncoated catheter	£1.30	^14
Cost per sachet of lubricant	£0.16	Optilube sterile lubricating jelly^28
Number of catheters used per day (both uncoated and hydrophilic-coated)	5	^4
Utility decrement for SCI catheter users	0.079	^14
Utility decrement for MS catheter users	0.327	^29
Utility decrement for uncoated catheter users (as opposed to hydrophilic)	0.017	^30

Table 2. Inputs predicting infection outcomes (independent of catheter type).

Parameter	Base case value	Source
Breakdown of UTIs
Simple infection treated in primary care	50%	Clinical opinion
Prolonged infection treated in primary care	25%
Complex infection treated in day case secondary care	3%
Complex infection treated in day case secondary care	17%
Infection with severe complications, not leading to death	4.25%
Infection leading to death	0.75%
Cost of treating each event type
Simple infection treated in primary care	£70	See Supplementary Material for further details.
Prolonged infection treated in primary care	£113
Complex infection treated in day case secondary care	£262	Weighted average of DC (day case) codes “kidney or urinary tract infections” (LA04L to LA04S) in NHS reference costs 2019/20^31.
Complex infection treated in day case secondary care	£2,879	Weighted average of NEL (non-elective inpatient) codes “kidney or urinary tract infections” (LA04H to LA04S) in NHS reference costs 2019/20^31.
Infection with severe complications, not leading to death	£5,924	^32
Infection leading to death	£10,426	Assumption: 1.76* the cost of an infection with severe complications, not leading to death.
Utility decrement for each event type
Simple infection treated in primary care	0.10	Assumption, validated by clinical opinion.
Prolonged infection treated in primary care	0.10
Complex infection treated in day case secondary care	0.15
Complex infection treated in day case secondary care	0.15
Infection with severe complications, not leading to death	0.17	^33
Infection leading to death	0.17	Assumption, validated by clinical opinion.
Duration of decrement for each event type (days)
Simple infection treated in primary care	7	Assumption, validated by clinical opinion.
Prolonged infection treated in primary care	14
Complex infection treated in day case secondary care	14
Complex infection treated in day case secondary care	28
Infection with severe complications, not leading to death	37	^27
Infection leading to death	65	^27

Table 3. Results of the evaluation.

Cost-effectiveness results per patient (over a lifetime) – means and 95% credible intervals
	Hydrophilic		Uncoated		Incremental
Cost per patient (discounted)	£75,322 (£60,440–£92,198)		£72,139 (£57,128–£89,566)		£3,183 (−£8,293–£14,665)
QALYs per patient (discounted)	8.05 (6.48–9.43)		7.50 (5.88–8.95)		0.55 (0.32–0.82)
Life years per patient (undiscounted)	20.07 (15.52–23.92)		19.10 (14.31–23.35)		0.97 (0.30–1.78)
Incremental cost effectiveness ratio (ICER)					£5,755 (−£15,521–£32,644)
Net monetary benefit (NMB), at a threshold of £20,000 per QALY gained					£7,878 (−£5,210–£20,616)
Probability of cost-effectiveness, at a threshold of £20,000 per QALY gained					89%
Predicted event counts per patient (over a lifetime)
	Hydrophilic	Uncoated		Incremental (events avoided)		NNT*
Simple infections, treated in primary care	27.3	30.9		3.5		1
Prolonged infections, treated in primary care	13.7	15.4		1.8		1
Complex infections requiring day case in hospital	1.6	1.9		0.2		5
Complex infections requiring inpatient stay in hospital	9.3	10.5		1.2		1
Infections with severe complications, not leading to death	2.3	2.6		0.3		4
Infections leading to death	0.41	0.46		0.05		19

*The number needed to treat (NNT), represents the number of people who would need to use HCICs rather than UICs (for their remaining lifetime) in order to avoid one such event.

Figure 2. Top panel ∼ Cost-effectiveness plane. Bottom panel ∼ Cost-effectiveness acceptability curve.

Figure 3. Tornado diagram.

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