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Cost-effectiveness of strategies preventing late-onset infection in preterm infants
Alessandro Grosso1, Rita Isabel Neves de Faria2, Laura Bojke2
1Centre for Health Economics, University of York, York, UK alessandro.grosso@york.ac.uk.
Insights
Preventing late-onset infection (LOI) in preterm infants is cost-effective, even with small risk reductions. Antimicrobial-impregnated peripherally inserted central catheters (AM-PICCs) are not cost-effective compared to standard PICCs.
Area of Science:
- Neonatal medicine
- Health economics
- Infectious disease prevention
Background:
- Late-onset infection (LOI) poses significant risks to preterm infants, including neurodevelopmental impairment (NDI).
- Evaluating the cost-effectiveness of interventions to prevent LOI is crucial for optimizing neonatal care.
- Standard peripherally inserted central catheters (S-PICCs) are commonly used, but antimicrobial-impregnated versions (AM-PICCs) are also available.
Purpose of the Study:
- To develop and apply a cost-effectiveness model for interventions preventing LOI in preterm infants.
- To evaluate the cost-effectiveness of AM-PICCs compared to S-PICCs in this population.
Main Methods:
- Model-based cost-effectiveness analysis using data from the PREVAIL trial and linked healthcare data.
- Incorporation of published literature to supplement data.
- Assumption that LOI increases the risk of NDI, impacting long-term outcomes and costs.
Main Results:
- Severe NDI significantly reduces life expectancy, quality-adjusted life years (QALYs), and incurs substantial healthcare costs.
- Interventions reducing LOI risk by 5% could justify an acquisition price of up to £120.
- AM-PICCs were found to increase costs (£54.85) with negligible impact on health outcomes (-0.01 QALYs) compared to S-PICCs.
Conclusions:
- Interventions preventing LOI can be highly cost-effective due to the significant long-term consequences of NDI.
- AM-PICCs are unlikely to be cost-effective due to higher costs and minimal health benefits over S-PICCs.
- The UK NHS could invest up to £2.4 million in research to confirm the non-cost-effectiveness of AM-PICCs.
Objective:
Developing a model to analyse the cost-effectiveness of interventions preventing late-onset infection (LOI) in preterm infants and applying it to the evaluation of anti-microbial impregnated peripherally inserted central catheters (AM-PICCs) compared with standard PICCs (S-PICCs).
Design:
Model-based cost-effectiveness analysis, using data from the Preventing infection using Antimicrobial Impregnated Long Lines (PREVAIL) randomised controlled trial linked to routine healthcare data, supplemented with published literature. The model assumes that LOI increases the risk of neurodevelopmental impairment (NDI).
Setting:
Neonatal intensive care units in the UK National Health Service (NHS).
Patients:
Infants born ≤32 weeks gestational age, requiring a 1 French gauge PICC.
Interventions:
AM-PICC and S-PICC.
Main Outcome Measures:
Life expectancy, quality-adjusted life years (QALYs) and healthcare costs over the infants' expected lifetime.
Results:
Severe NDI reduces life expectancy by 14.79 (95% CI 4.43 to 26.68; undiscounted) years, 10.63 (95% CI 7.74 to 14.02; discounted) QALYs and costs £19 057 (95% CI £14 197; £24697; discounted) to the NHS. If LOI causes NDI, the maximum acquisition price of an intervention reducing LOI risk by 5% is £120. AM-PICCs increase costs (£54.85 (95% CI £25.95 to £89.12)) but have negligible impact on health outcomes (-0.01 (95% CI -0.09 to 0.04) QALYs), compared with S-PICCs. The NHS can invest up to £2.4 million in research to confirm that AM-PICCs are not cost-effective.
Conclusions:
The model quantifies health losses and additional healthcare costs caused by NDI and LOI during neonatal care. Given these consequences, interventions preventing LOI, even by a small extent, can be cost-effective. AM-PICCs, being less effective and more costly than S-PICC, are not likely to be cost-effective.
Trial Registration Number:
NCT03260517.
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