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Updated: Jan 6, 2026

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Seven-Day vs Four-Day Infusion Set Replacement Interval and Catheter-Related Infections.

Shalini Elangovan1, Yiying Cai1, Brett G Mitchell2,3,4

  • 1Programme in Health Services Research and Population Health, Duke-NUS Medical School, Singapore.

JAMA Network Open
|December 2, 2025
PubMed
Summary
This summary is machine-generated.

Extending central venous catheter replacement intervals to 7 days from 4 days may save healthcare costs but leads to substantial population-level health losses, including increased infections and deaths. Decision-making should consider these trade-offs beyond arbitrary equivalence margins.

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Area of Science:

  • Health economics
  • Infectious disease prevention
  • Clinical trial analysis

Background:

  • Catheter-related bloodstream infections (CRBSIs) increase hospital stays and mortality.
  • The RSVP trial suggested extending catheter replacement intervals from 4 to 7 days was safe regarding infection risk.
  • The RSVP trial did not fully evaluate cost and health trade-offs of extended intervals.

Purpose of the Study:

  • To estimate cost and health benefit changes from adopting 7-day vs. 4-day catheter replacement intervals.
  • To conduct an economic evaluation using decision-analytic modeling.
  • To analyze the clinical and economic impacts of CRBSI risk changes.

Main Methods:

  • Developed a decision tree model from a healthcare perspective.
  • Incorporated data from the RSVP randomized clinical trial (2011-2016).
  • Performed probabilistic sensitivity analysis and value of information analysis.

Main Results:

  • The 7-day strategy yielded significant annual cost savings (approx. A$52 million) but was linked to increased CRBSI treatment costs.
  • Population-level outcomes included potential excess infections, deaths, and life-years lost.
  • At a willingness-to-pay threshold of A$28,033, the 7-day strategy had a 50.3% probability of being cost-effective and 82.67% probability of being cost-saving.

Conclusions:

  • Extending catheter replacement intervals to 7 days offers substantial cost savings but incurs significant population health losses.
  • Arbitrary equivalence margins (e.g., 2% infection risk increase) may obscure critical decision-making information.
  • Clinical and economic impacts of even small infection increases are crucial for informed healthcare decisions.