186. The Cost-Effectiveness of the Silver Coated Needleless Connector (NC) to Prevent Central Line-associated Bloodstream Infections (CLABSI)
Session: Poster Abstract Session: Catheter-associated BSIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • ID Week CEA 092313.pdf (358.8 kB)
  • Background: A crossover trial at our institutions found that a silver-coated (novel) NC decreased CLABSI rates compared to a mechanically identical standard NC. We sought to model the relative costs and benefits of the standard NC and novel NC, which has a higher acquisition cost.

    Methods: A decision tree was created to analyze the cost-effectiveness of the novel vs. standard NC. Factors assessed included estimated CLABSI costs, device costs (based on publicly available prices), and probability of CLABSI (based on the results of the dual center crossover study). Each patient was assumed to have used 1 device per lumen of a central line, with a median of 6 days of catheter duration (interquartile range 3-11) and with each NC changed every 7 days resulting in an average of 4.5 NC per patient. A one-way sensitivity analysis, based on experience from our trial, assumed that the novel NC device was changed more frequently than the alternative (the opaqueness of the novel catheter hampers assessment of blood in the NC lumen), and increased until the benefit of the NC was offset (threshold value). The incremental cost-effectiveness ratio (ICER) was used to estimate the cost to prevent 1 CLABSI in 100 patients.

    Results: The novel NC resulted in 0.65 fewer infections per 100 patients over the course of the study. The difference in cost between the silver coated NC and the standard NC was $490.50 per 100 patients. The ICER for the novel NC was $754.62. The sensitivity analysis required an increased rate of change of novel NC of 34% to eliminate cost savings.

    Conclusion: In addition to preventing CLABSIs, a novel NC can be cost-effective. . However, factors such as baseline CLABSI rate, patient population, line utilization and length of stay should be considered when assessing the effectiveness of any device. A large increase in device turnover among the novel NC would be necessary to pass the threshold value and eliminate cost savings.

    Chad Robichaux, BA, Emory Healthcare, Atlanta, GA, Jesse T. Jacob, MD, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, Sheri Chernetsky Tejedor, MD, Internal Medicine, Emory University School of Medicine, Atlanta, GA, Jay Varkey, MD, Emory University, Atlanta, GA and James Steinberg, MD, Emory University School of Medicine, Atlanta, GA


    C. Robichaux, None

    J. T. Jacob, None

    S. Chernetsky Tejedor, None

    J. Varkey, None

    J. Steinberg, None

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