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Cost-effectiveness of prophylactic antibiotic use to prevent catheter-associated urinary tract infections

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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.

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Fig. 1

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Funding

This work was conducted with support from Harvard Catalyst/The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic health care centers. The funding sources had no involvement in the study design, collection, analysis, or interpretation of data, the writing of the report, or the decision to submit the article for publication.

Author information

Correspondence to Roger Lefevre.

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The authors report no conflict of interest.

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Wang, R., Hacker, M.R. & Lefevre, R. Cost-effectiveness of prophylactic antibiotic use to prevent catheter-associated urinary tract infections. Int Urogynecol J 31, 285–289 (2020). https://doi.org/10.1007/s00192-019-04034-4

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Keywords

  • Costs and cost analysis
  • Cost-benefit analysis
  • Antibiotic prophylaxis
  • Urinary tract infections
  • Catheter-related infections