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J Am Geriatr Soc. 2018 Apr;66(4):742-747. doi: 10.1111/jgs.15316. Epub 2018 Feb 28.

Economic Evaluation of a Catheter-Associated Urinary Tract Infection Prevention Program in Nursing Homes.

Author information

1
Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan.
2
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
3
Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
4
School of Public Health and Biomedical Innovation, Queensland University of Technology, Australia.
5
Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia.
6
Cellular and Molecular Biology, University of Michigan, Ann Arbor, Michigan.
7
Division of Geriatric and Palliative Care Medicine, School of Medicine, University of Michigan Ann Arbor, Michigan.
8
Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.

Abstract

OBJECTIVE:

To assess the economic effect and cost effectiveness of a targeted catheter-associated urinary tract infection (CAUTI) prevention intervention in the nursing home (NH) setting.

DESIGN:

Randomized clinical trial.

SETTING:

Community-based NHs (N=12).

PARTICIPANTS:

NH residents with indwelling urinary catheters (N=418).

INTERVENTION:

Standard care versus infection prevention program involving barrier precautions, active surveillance, and NH staff education.

MEASUREMENTS:

Costs of the intervention, costs of disease, and health outcomes were used to calculate an incremental cost-effectiveness ratio for the intervention. Data came from intervention results and the literature and outcomes were analyzed over one year.

RESULTS:

A 120-bed NH would have program costs of $20,279/year. The cost of disease treatment would be reduced by $54,316 per year, resulting in a $34,037 net cost savings. Most of this savings would come from fewer CAUTI hospitalizations ($39,180), with $15,136 in savings from CAUTI care within the NH. The intervention also yielded a gain of 0.197 quality-adjusted life-years (QALYs). Taking into account uncertainty in all parameters suggests there is an 85% chance that the intervention is cost-saving.

CONCLUSIONS:

The CAUTI prevention program is expected to benefit payers by reducing costs and improving health outcomes. Because the savings accrue to payers and not to NHs, payers such as Medicare and private insurers may want to provide incentives for NHs to implement such programs.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT01062841.

KEYWORDS:

catheter-related infections; cost-effectiveness; drug resistance, multiple; nursing homes

PMID:
29489017
PMCID:
PMC6374025
DOI:
10.1111/jgs.15316
[Indexed for MEDLINE]
Free PMC Article

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