RT Journal Article
SR Electronic
T1 Cost-effectiveness of strategies preventing late-onset infection in preterm infants
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 452
OP 457
DO 10.1136/archdischild-2019-317640
VO 105
IS 5
A1 Alessandro Grosso
A1 Rita Isabel Neves de Faria
A1 Laura Bojke
A1 Chloe Donohue
A1 Caroline Isabel Fraser
A1 Katie L Harron
A1 Sam J Oddie
A1 Ruth Gilbert
YR 2020
UL http://adc.bmj.com/content/105/5/452.abstract
AB 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.