Background: Antibiotic-impregnated central venous catheters (CVCs) reduce the risk of
bloodstream infections (BSIs) in patients treated in pediatric intensive care units (PICUs).
However, it is unclear if they are cost-effective from the perspective of the National Health
Service (NHS) in the UK.
Methods: Economic evaluation alongside the CATCH trial (ISRCTN34884569) to
estimate the incremental cost effectiveness ratio (ICER) of antibiotic-impregnated
(rifampicin and minocycline), heparin-bonded and standard polyurethane CVCs. The
6-month costs of CVCs and hospital admissions and visits were determined from
administrative hospital data and case report forms.
Results: BSIs were detected in 3.59% (18/502) of patients randomized to standard,
1.44% (7/486) to antibiotic and 3.42% (17/497) to heparin CVCs. Lengths of hospital stay
did not differ between intervention groups. Total mean costs (95% confidence interval)
were: £45,663 (£41,647–£50,009) for antibiotic, £42,065 (£38,322–£46,110) for heparin,
and £44,503 (£40,619–£48,666) for standard CVCs. As heparin CVCs were not clinically
effective at reducing BSI rate compared to standard CVCs, they were considered not to
be cost-effective. The ICER for antibiotic vs. standard CVCs, of £54,057 per BSI avoided,
was sensitive to the analytical time horizon.
Conclusions: Substituting standard CVCs for antibiotic CVCs in PICUs will result in
reduced occurrence of BSI but there is uncertainty as to whether this would be a
cost-effective strategy for the NH