Document Detail

Intermittent self catheterisation with hydrophilic, gel reservoir, and non-coated catheters: a systematic review and cost effectiveness analysis.
MedLine Citation:
PMID:  23303886     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine the most effective and cost effective type of catheter for patients performing intermittent self catheterisation in the community.
DESIGN: Systematic review and meta-analysis. Results were incorporated into a probabilistic Markov model to compare lifetime costs and quality adjusted life years (QALYs).
DATA SOURCES: We searched Medline, Embase, and Cochrane and Cinahl databases from 2002 to 18 April 2011 to identify studies comparing hydrophilic, gel reservoir, and non-coated intermittent catheters. Earlier guidelines were used to identify papers published before 2002. To capture studies comparing clean and sterile non-coated intermittent self catheterisation, each database was searched from its date of inception to 18 April 2011.
MAIN OUTCOME MEASURES: Clinical outcomes included symptomatic urinary tract infection (UTI), bacteraemia, mortality, patient preference or comfort, and number of catheters used. The economic model included downstream complications of UTI and cost effectiveness was calculated as incremental cost per QALY gained.
RESULTS: Eight studies were included in the systematic review. Most were conducted in patients with spinal cord injuries, and most of the included patients were men. People using gel reservoir and hydrophilic catheters were significantly less likely to report one or more UTIs compared with sterile non-coated catheters (absolute effect for gel reservoir = 149 fewer per 1000 (95% confidence interval -7 to 198), P=0.04; absolute effect for hydrophilic = 153 fewer per 1000 (-8 to 268), P=0.04). However, there was no difference between hydrophilic and sterile non-coated catheters when outcomes were measured as mean monthly UTIs (mean difference = 0.01 (-0.11 to 0.09), P=0.84) or total UTIs at 1 year (mean difference = 0.18 (-0.50 to 0.86), P=0.60). There was little difference in the incidence of one or more UTIs for people using clean versus sterile non-coated catheters (absolute effect = 12 fewer per 1000 (-134 to 146), P=0.86). Although the most effective, gel reservoir catheters cost >£54,350 per QALY gained and are therefore not cost effective compared with clean non-coated self catheterisation.
CONCLUSION: The type of catheter used for intermittent self catheterisation seems to make little difference to the risk of symptomatic UTI. Given large differences in resource use, clean non-coated catheters are most cost effective. However, because of limitations and gaps in the evidence base and the designation of non-coated catheters as single use devices, we recommend a precautionary principle should be adopted and that patients should be offered a choice between hydrophilic and gel reservoir catheters.
Sarah L Bermingham; Sarah Hodgkinson; Sue Wright; Ellie Hayter; Julian Spinks; Carol Pellowe
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review     Date:  2013-01-08
Journal Detail:
Title:  BMJ (Clinical research ed.)     Volume:  346     ISSN:  1756-1833     ISO Abbreviation:  BMJ     Publication Date:  2013  
Date Detail:
Created Date:  2013-01-10     Completed Date:  2013-02-25     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  8900488     Medline TA:  BMJ     Country:  England    
Other Details:
Languages:  eng     Pagination:  e8639     Citation Subset:  AIM; IM    
Royal College of Physicians, National Clinical Guideline Centre, London NW1 4LE, UK.
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MeSH Terms
Ambulatory Care / economics
Catheters / adverse effects,  economics*
Community Health Services / economics
Cost-Benefit Analysis
Drug Resistance, Microbial
Equipment Design / economics
Gels / economics*
Markov Chains
Patient Preference
Quality of Life
Quality-Adjusted Life Years
Self Care / adverse effects,  economics*
Treatment Outcome
Urethral Diseases / economics,  etiology,  prevention & control
Urinary Bladder Diseases / economics,  therapy
Urinary Catheterization / economics*,  methods
Urinary Tract Infections / economics,  etiology*,  prevention & control
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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