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

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.

Figure 1.

Schematic of decision tree model. The figure should be read from left to right. The square represents the intervention decision. Circles represent uncertain outcomes for nursing home residents: whether they develop a catheter-associated urinary tract infection (CAUTI), whether they are hospitalized, and whether they have septicemia, given hospitalization.