Cost-Effectiveness Analysis of Clinically Indicated Versus Routine Replacement of Peripheral Intravenous Catheters

Abstract

Background

Millions of peripheral intravenous catheters are used worldwide. The current guidelines recommend routine catheter replacement every 72–96 h. This practice requires increasing healthcare resource use. The clinically indicated catheter replacement strategy is proposed as an alternative.

Objectives

To assess the cost effectiveness of clinically indicated versus routine replacement of peripheral intravenous catheters.

Methods

A cost-effectiveness analysis from the perspective of Queensland Health, Australia, was conducted alongside a randomized controlled trial. Adult patients with an intravenous catheter of expected use for longer than 4 days were randomly assigned to receive either clinically indicated replacement or third-day routine replacement. The primary outcome was phlebitis during catheterization or within 48 h after catheter removal. Resource use data were prospectively collected and valued (2010 prices). The incremental net monetary benefit was calculated with uncertainty characterized using bootstrap simulations. Additionally, value of information (VOI) and value of implementation analyses were performed.

Results

The clinically indicated replacement strategy was associated with a cost saving per patient of AU$7.60 (95 % confidence interval [CI] 4.96–10.62) and a non-significant difference in the phlebitis rate of 0.41 % (95 % CI −1.33 to 2.15). The incremental net monetary benefit was AU$7.60 (95 % CI 4.96–10.62). The expected VOI was zero, whereas the expected value of perfect implementation of the clinically indicated replacement strategy was approximately AU$5 million over 5 years.

Conclusion

The clinically indicated catheter replacement strategy is cost saving compared with routine replacement. It is recommended that healthcare organizations consider changing to a policy whereby catheters are changed only if clinically indicated.

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Acknowledgements

The Australian Centre for Health Services Innovation funded this study through its competitive stimulus grants scheme.

H.T. is supported by an NHMRC PhD scholarship through the NHMRC Centre for Research Excellence in Nursing Interventions for Hospital Patients.

Conflict of Interest/Disclosure

The authors declare no conflict of interest.

Author Contributions

All authors made substantial contributions to the writing and the final review of the manuscript. H.T., L.G. and P.S. performed the economic analysis. C.R., N.M., J.W. and M.W. contributed to the acquisition and analysis of the clinical data. H.T. is the guarantor for the overall content.

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Correspondence to Haitham W. Tuffaha.

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Tuffaha, H.W., Rickard, C.M., Webster, J. et al. Cost-Effectiveness Analysis of Clinically Indicated Versus Routine Replacement of Peripheral Intravenous Catheters. Appl Health Econ Health Policy 12, 51–58 (2014). https://doi.org/10.1007/s40258-013-0077-2

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Keywords

  • Phlebitis
  • Intravenous Catheter
  • Catheter Replacement
  • Queensland Health
  • Peripheral Venous Catheter