Cost-effectiveness of long-term intermittent catheterisation with hydrophilic and uncoated catheters in traumatic spinal cord injury in Australia

Abstract

Aims:To model the cost-effectiveness of hydrophilic coated intermittent catheters (HCIC) compared with uncoated catheters (UC) for intermittent catheterisation in Australians with neurogenic bladder from traumatic spinal cord injury (SCI). Methods:A published probabilistic Markov model was adapted for Australia to compare lifetime costs and quality-adjusted life years for the two catheter types in SCI Australians who intermittently catheterise. The primary analysis was from the Australian healthcare perspective with a supplementary societal perspective analysis that incorporated costs from lost productivity. Results:Lifetime UTI events were reduced by 10% with HCIC use. If every Australian with SCI who undertakes self-catheterisation used HCIC over their lifetime, the modelled decrease in UTI incidence would result in a cost saving of approximately $299,000,000. The incremental cost-effectiveness ratio (ICER) of $48,542 was below the threshold of $50,000 to $60,000 cost per quality-adjusted life year (QALY) informally interpreted as showing cost-effectiveness of medical technologies and pharmaceuticals in Australia. When the societal perspective was taken, HCIC use produced superior clinical outcomes at a lower total cost compared with UCs. Conclusion:UTI was the most common complication leading to readmission in the 2 years following traumatic SCI, hence reducing UTI incidence has a significant impact on both an individual’s quality of life and on total healthcare costs. The ICER results from the base case and sensitivity analyses suggest that use of HCIC in Australia is cost-effective.