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Cost-effectiveness of strategies preventing late-onset infection in preterm infants
  1. Alessandro Grosso1,
  2. Rita Isabel Neves de Faria1,
  3. Laura Bojke1,
  4. Chloe Donohue2,
  5. Caroline Isabel Fraser3,
  6. Katie L Harron3,
  7. Sam J Oddie4,5,
  8. Ruth Gilbert6
  1. 1Centre for Health Economics, University of York, York, UK
  2. 2Clinical Trials Research Centre, University of Liverpool, Liverpool, Merseyside, UK
  3. 3UCL Great Ormond Street Institute of Child Health, London, United Kingdom
  4. 4Bradford Neonatology, Bradford Royal Infirmary, West Yorkshire, UK
  5. 5Centre for Reviews and DIssemination University of York, York, United Kingdom
  6. 6MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, United Kingdom
  1. Correspondence to Alessandro Grosso, Centre for Health Economics, University of York, York YO10 5DD, UK; alessandro.grosso{at}york.ac.uk

Abstract

Objective Developing a model to analyse the cost-effectiveness of interventions preventing late-onset infection (LOI) in preterm infants and applying it to the evaluation of anti-microbial impregnated peripherally inserted central catheters (AM-PICCs) compared with standard PICCs (S-PICCs).

Design Model-based cost-effectiveness analysis, using data from the Preventing infection using Antimicrobial Impregnated Long Lines (PREVAIL) randomised controlled trial linked to routine healthcare data, supplemented with published literature. The model assumes that LOI increases the risk of neurodevelopmental impairment (NDI).

Setting Neonatal intensive care units in the UK National Health Service (NHS).

Patients Infants born ≤32 weeks gestational age, requiring a 1 French gauge PICC.

Interventions AM-PICC and S-PICC.

Main outcome measures Life expectancy, quality-adjusted life years (QALYs) and healthcare costs over the infants’ expected lifetime.

Results Severe NDI reduces life expectancy by 14.79 (95% CI 4.43 to 26.68; undiscounted) years, 10.63 (95% CI 7.74 to 14.02; discounted) QALYs and costs £19 057 (95% CI £14 197; £24697; discounted) to the NHS. If LOI causes NDI, the maximum acquisition price of an intervention reducing LOI risk by 5% is £120. AM-PICCs increase costs (£54.85 (95% CI £25.95 to £89.12)) but have negligible impact on health outcomes (−0.01 (95% CI −0.09 to 0.04) QALYs), compared with S-PICCs. The NHS can invest up to £2.4 million in research to confirm that AM-PICCs are not cost-effective.

Conclusions The model quantifies health losses and additional healthcare costs caused by NDI and LOI during neonatal care. Given these consequences, interventions preventing LOI, even by a small extent, can be cost-effective. AM-PICCs, being less effective and more costly than S-PICC, are not likely to be cost-effective.

Trial registration number NCT03260517.

  • prematurity
  • late-onset infection
  • neurodevelopment
  • cost-effectiveness
  • NNRD

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Contributors AG, RINdeF and LB conceptualised the model with valuable input from SJO and RG. CD, CIF and KLH provided valuable assistance in obtaining access to the data. AG and RINdeF performed the main analysis with support from LB. All authors provided input in the interpretation of the study results. AG led the drafting of the manuscript with support from RINdeF and LB. All authors contributed to the editing of the manuscript. All authors read and approved the final manuscript.

  • Funding This research was funded by the National Institute for Health Research (NIHR)—Health Technology Assessment (HTA) Programme 12/167/02. AG is funded by the National Institute for Health Research (NIHR)—Research Methods Fellowship Programme NIHR-RMFI-2016-07-16.

  • Disclaimer Access to the fully anonymised PREVAIL Trial datasets and data dictionary can be obtained by applying to the Clinical Trials Research Centre (University of Liverpool, Liverpool, UK), who will liaise with the investigators to approve the proposal and ensure that a signed data access agreement is in place before releasing the data. Electronic patient data recorded at participating neonatal units that collectively form the United Kingdom Neonatal Collaborative (UKNC) are transmitted to the Neonatal Data Analysis Unit (NDAU) to form the National Neonatal Research Database (NNRD). LB, RINdeF and AG had full access to all the data in the study and take full responsibility for the integrity of the data and accuracy of the data analysis. The Paediatric Intensive Care Audit Network (PICANet) is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP), the Welsh Health Specialised Services, NHS Lothian/National Services Division NHS Scotland, the Royal Belfast Hospital for Sick Children, The National Office of Clinical Audit (NOCA), Republic of Ireland and HCA Healthcare UK. HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement in patient outcomes, and in particular, to increase the impact that clinical audit, outcome review programmes and registries have on healthcare quality in England and Wales. HQIP holds the contract to commission, manage and develop the NCAPOP, comprising around 40 projects covering care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual projects, other devolved administrations and crown dependencies. www.hqip.org.uk/national-programmes. This research was informed by data collected by NHS Digital (former Health and Social Care Information Centre). Copyright 2015–2018, the Health and Social Care Information Centre. Re-used with the permission of the Health and Social Care Information Centre. All rights reserved.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Data may be obtained from a third party and are not publicly available.

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