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The Potential Clinical and Economic Benefits of Silver Alloy Urinary Catheters in Preventing Urinary Tract Infection
Sanjay Saint, MD, MPH;
David L. Veenstra, PharmD, PhD;
Sean D. Sullivan, PhD;
Carol Chenoweth, MD;
A. Mark Fendrick, MD
Arch Intern Med. 2000;160:2670-2675.
Background Catheter-associated urinary tract infection (UTI) is associated with increased morbidity, mortality, and costs. A recent meta-analysis concluded that silver alloy catheters reduce the incidence of UTI by 3-fold; however, clinicians must decide whether the efficacy of such catheters is worth the extra per unit cost of $5.30.
Objective To assess the clinical and economic impact of using silver alloy urinary catheters in hospitalized patients.
Methods The decision model, performed from the health care payer's perspective, evaluated a simulated cohort of 1000 hospitalized patients on general medical, surgical, urologic, and intensive care services requiring short-term urethral catheterization (2-10 days). We compared 2 catheterization strategies: silver alloy catheters and standard (noncoated) urinary catheters. Outcomes included the incidence of symptomatic UTI and bacteremia and direct medical costs.
Results In the base-case analysis, use of silver-coated catheters led to a 47% relative decrease in the incidence of symptomatic UTI from 30 to 16 cases per 1000 patients (number needed to treat = 74) and a 44% relative decrease in the incidence of bacteremia from 4.5 to 2.5 cases per 1000 patients (number needed to treat = 500) compared with standard catheters. Use of silver alloy catheters resulted in estimated cost savings of $4.09 per patient compared with standard catheter use ($20.87 vs $16.78). In a multivariate sensitivity analysis using Monte Carlo simulation, silver-coated catheters provided clinical benefits over standard catheters in all cases and cost savings in 84% of cases.
Conclusions Using silver alloy catheters in hospitalized patients requiring short-term urinary catheterization reduces the incidence of symptomatic UTI and bacteremia, and is likely to produce cost savings compared with standard catheters.
From the Divisions of General Medicine (Drs Saint and Fendrick) and Infectious Diseases (Dr Chenoweth), Department of Internal Medicine, The University of Michigan Health System, Ann Arbor; and the Department of Pharmacy, University of Washington, Seattle (Drs Veenstra and Sullivan). None of the authors has received financial support from or holds any personal financial interest in the manufacturer of silver alloy urinary catheters.
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