Background & aims: Catheter-related bloodstream infections (CRBSIs) are a major complication in patients with chronic intestinal failure (CIF) dependent on home parenteral support (HPS), contributing substantially to morbidity, mortality, and costs. Taurolidine-containing catheter lock solutions reduce CRBSIs, but data on cost-effectiveness remain limited.
Methods: This cost-effectiveness analysis used data from a double-blind, randomized controlled trial (2019-2022; ClinicalTrials.gov: NCT06660641) comparing 1.35% taurolidine with 0.9% saline as catheter lock solutions for secondary prevention of recurrent CRBSIs in 61 adults with CIF and a history of CRBSI. Economic analyses adopted a healthcare-provider perspective and included direct medical costs related to treatment and CRBSI management. Clinical outcomes were evaluated using recurrent-event methods, and costs were estimated using Diagnosis-Related Group (DRG) tariffs and a micro-costing approach (MCAP). Incremental cost-effectiveness ratios (ICERs) were calculated.
Results: Taurolidine significantly reduced recurrent CRBSIs (ratio: 0.23; 95% CI: 0.09-0.60; p = 0.0028) and associated CVC removals (ratio: 0.09; 95% CI: 0.02-0.41; p = 0.0019). The number needed to treat was 2.4 patients per year. Patients in the taurolidine group had fewer admission days (mean 3.3 vs 16.0; p = 0.015). Despite higher acquisition costs, taurolidine reduced the total hospital expenditures by 39% (DRG) to 64% (MCAP). Mean savings per patient at 24 months were €6395 (DRG; p = 0.016) and €15,434 (MCAP; p = 0.014). Taurolidine also reduced the probability of extreme high-cost CRBSI episodes. Incremental cost-effectiveness ratios (ICERs) indicated dominance, with 94.5-99.6% of bootstrap replications showing taurolidine to be more effective and less costly.
Conclusion: In patients with CIF and prior CRBSI, 1.35% taurolidine is a clinically superior and cost-saving secondary prevention strategy that reduces recurrent CRBSIs, CVC removals, and hospital resource use. These findings support routine use in secondary prevention and highlight the need to evaluate taurolidine for primary prevention, where early risk stratification remains challenging.
Reference:Nerstrøm CT, Scheike T, Moser CE, Tribler S, Jeppesen PB. Cost-effectiveness of Taurolidine as secondary prevention of recurrent catheter-related bloodstream infections in patients with chronic intestinal failure: Findings from a randomized controlled trial. Clin Nutr. 2026 May 22;62:106694. doi: 10.1016/j.clnu.2026.106694. Epub ahead of print. PMID: 42235100.