Cost-effectiveness analysis of chlorhexidine-alcohol versus povidone iodine-alcohol solution in the prevention of intravascular-catheter-related bloodstream infections in France.

OBJECTIVE: To perform a cost-effectiveness analysis of skin antiseptic solutions (chlorhexidine-alcohol (CHG) versus povidone iodine-alcohol solution (PVI)) for the prevention of intravascular-catheter-related bloodstream infections (CRBSI) in intensive care unit (ICU) in France based on an open-label, multicentre, randomised, controlled trial (CLEAN). DESIGN: A 100-day time semi-markovian model was performed to be fitted to longitudinal individual patient data from CLEAN database. This model includes eight health states and probabilistic sensitivity analyses on cost and effectiveness were performed. Costs of intensive care unit stay are based on a French multicentre study and the cost-effectiveness criterion is the cost per patient with catheter-related bloodstream infection avoided. PATIENTS: 2,349 patients (age≥18 years) were analyzed to compare the 1-time CHG group (CHG-T1, 588 patients), the 4-time CHG group (CHG-T4, 580 patients), the 1-time PVI group (PVI-T1, 587 patients), and the 4-time PVI group (PVI-T4, 594 patients). INTERVENTION: 2% chlorhexidine-70% isopropyl alcohol (chlorhexidine-alcohol) compared to 5% povidone iodine-69% ethanol (povidone iodine-alcohol). RESULTS: The mean cost per alive, discharged or dead patient was of €23,798 (95% confidence interval: €20,584; €34,331), €21,822 (€18,635; €29,701), €24,874 (€21,011; €31,678), and €24,201 (€20,507; €29,136) for CHG-T1, CHG-T4, PVI-T1, and PVI-T4, respectively. The mean number of patients with CRBSI per 1000 patients was of 3.49 (0.42; 12.57), 6.82 (1.86; 17.38), 26.04 (14.64; 42.58), and 23.05 (12.32; 39.09) for CHG-T1, CHG-T4, PVI-T1, and PVI-T4, respectively. In comparison to the 1-time PVI solution, the 1-time CHG solution avoids 22.55 CRBSI /1,000 patients, and saves €1,076 per patient. This saving is not statistically significant at a 0.05 level because of the overlap of 95% confidence intervals for mean costs per patient in each group. Conversely, the difference in effectiveness between the CHG-T1 solution and the PVI-T1 solution is statistically significant. CONCLUSIONS: The CHG-T1 solution is more effective at the same cost than the PVI-T1 solution. CHG-T1, CHG-T4 and PVI-T4 solutions are statistically comparable for cost and effectiveness. This study is based on the data from the RCT from 11 French intensive care units registered with www.clinicaltrials.gov (NCT01629550).

Cost analysis of dental services needed before hematopoietic cell transplantation.

OBJECTIVE: Streptococcal bacteremia occurs during hematopoietic cell transplantation (HCT), and treatment of active oral disease may reduce this risk. The objective of this study was to determine the type, number, and costs of pre-transplantation dental procedures in this population. STUDY DESIGN: Data were collected retrospectively from the records of patients who were to undergo HCT. The type, number, and costs of dental procedures were determined based on median charges of MassHealth (the Medicaid program in Massachusetts) and also on the median "usual and customary" fees charged by dentists in Massachusetts. RESULTS: A total of 405 patients were evaluated. There were 243 men (60%) and 162 women, with a median age of 53 years. The median and average costs (in US dollars) of dental treatment before HCT were $275 and $384, respectively, for patients covered by MassHealth and $368 and $522, respectively, for those with private insurance, adjusted to 2012 levels. CONCLUSIONS: Dental evaluation before HCT is an economical way for patients to minimize the risk of localized infection and possibly reduce the risk of bacteremia that may prolong the length of hospitalization.

Drug cost implications for antibiotic prophylaxis for dental procedures.

OBJECTIVE: To determine the potential economic impact from the practice of antibiotic prophylaxis for dental procedures. STUDY DESIGN: We estimated the prevalence of patients in the United States with 15 medical conditions and devices. We multiplied the prevalence for each patient population by the percentage of specialists recommending prophylaxis, then by the estimated number of dental office visits per year, and then by an average pharmacy cost to arrive at a total estimated range of annual cost for this practice. RESULTS: The 15 medical conditions and devices included in the present study involve upward of 20 million people and an estimated annual cost between $19,880,279 and $143,685,823. The actual cost may be far greater because of an underestimation of these prevalence figures and the use of antibiotic prophylaxis for additional patient populations. CONCLUSIONS: Our data suggest a significant cost for antibiotic prophylaxis in the dental practice setting and the need for evidence-based recommendations concerning this practice.