Abstract:
Background: A new medical device was developed for multi-infusion in neonatal intensive care units (NICUs) with the aim to address issues related to drug incompatibilities and central line-associated bloodstream infections (CLABSI).
Aim: To assess the cost-effectiveness of implementing this new perfusion system in a NICU setting.
Methods: We conducted a single-centre, observational study in all infants admitted to the NICU within the first 3 days after birth and who required central-venous line, to evaluate the cost and effectiveness before (Year 2019) and after (Year 2020) the implementation of the new perfusion system. We calculated the costs from the hospital perspective, and we examined the incidence of CLABSI, over a time horizon spanning from admission to NICU discharge. We measured the resource utilisation (infusion medical device, infection treating drugs and biological analyses), and valued corresponding costs using tariffs for year 2019. We calculated incremental cost-effectiveness ratio (ICER) expressed as euros per CLABSI avoided, and conducted one-way and multivariate sensitivity analyses.
Findings: Among 609 infants selected, clinical characteristics were similar across both periods. The CLABSI rate significantly decreased (rate ratio: 0.22; IC95% [0.07-0.56]), and total costs were reduced (from €65,666 to €63,932 per 1000 catheter days respectively; p<0.001), yielding to an ICER of €251 saved per CLABSI avoided. The majority of sensitivity analyses showed the new intervention remaining economically dominant.
Conclusion: This single-centre study showed a significant decrease in the incidence of CLABSI without incurring additional costs. Further prospective multicentre randomised studies are needed to confirm these results in other NICU.
Reference:Martelin A, Picaud JC, Faton S, Pradat P, Pastor-Diez B, Haÿs S, Armoiry X. Cost-effectiveness of a new multi-lumen infusion device to reduce central venous line-associated bloodstream infections in neonates. J Hosp Infect. 2024 Jul 18:S0195-6701(24)00249-4. doi: 10.1016/j.jhin.2024.06.019. Epub ahead of print. PMID: 39032568.