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Miller T, Lange D, Kizhakkedathu JN, Yu K, Felix D, Samejima S, Shackleton C, Malik RN, Sachdeva R, Walter M, Krassioukov AV. The Microbiological Burden of Short-Term Catheter Reuse in Individuals with Spinal Cord Injury: A Prospective Study. Biomedicines 2023; 11:1929. [PMID: 37509568 PMCID: PMC10377649 DOI: 10.3390/biomedicines11071929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Despite the risk of developing catheter-associated urinary tract infections (CAUTI), catheter reuse is common among people with spinal cord injury (SCI). This study examined the microbiological burden and catheter surface changes associated with short-term reuse. Ten individuals with chronic SCI reused their catheters over 3 days. Urine and catheter swab cultures were collected daily for analysis. Scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS) analyses were used to assess catheter surface changes. Catheter swab cultures showed no growth after 48 h (47.8%), skin flora (28.9%), mixed flora (17.8%), or bacterial growth (5.5%). Asymptomatic bacteriuria was found for most participants at baseline (n = 9) and all at follow-up (n = 10). Urine samples contained Escherichia coli (58%), Klebsiella pneumoniae (30%), Enterococcus faecalis (26%), Acinetobacter calcoaceticus-baumannii (10%), Pseudomonas aeruginosa (6%) or Proteus vulgaris (2%). Most urine cultures showed resistance to one or more antibiotics (62%). SEM images demonstrated structural damage, biofilm and/or bacteria on all reused catheter surfaces. XPS analyses also confirmed the deposition of bacterial biofilm on reused catheters. Catheter surface changes and the presence of antibiotic-resistant bacteria were evident following short-term reuse, which may increase susceptibility to CAUTI in individuals with SCI despite asymptomatic bacteriuria.
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Affiliation(s)
- Tiev Miller
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Dirk Lange
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The Stone Centre at Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Jayachandran N Kizhakkedathu
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Centre for Blood Research, Life Science Institute, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The School of Biomedical Engineering, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Kai Yu
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Centre for Blood Research, Life Science Institute, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Demian Felix
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The Stone Centre at Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Soshi Samejima
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Claire Shackleton
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Raza N Malik
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Department of Urology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC V5Z 2G9, Canada
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Barken KB, Vaabengaard R. A scoping review on the impact of hydrophilic versus non-hydrophilic intermittent catheters on UTI, QoL, satisfaction, preference, and other outcomes in neurogenic and non-neurogenic patients suffering from urinary retention. BMC Urol 2022; 22:153. [PMID: 36123663 PMCID: PMC9487088 DOI: 10.1186/s12894-022-01102-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For patients suffering from urinary retention due to neurogenic [e.g., spinal cord injury (SCI), spina bifida (SB), multiple sclerosis (MS)] or non-neurogenic [e.g., cancer, benign prostate hypertrophy (BPH)] causes, intermittent catheterization is the primary choice for bladder emptying. This scoping review compared hydrophilic-coated intermittent catheters (HCICs) with non-hydrophilic (uncoated) catheters in neurogenic and non-neurogenic patients with respect to satisfaction, preference, adverse events, urinary tract infection (UTI), quality of life (QoL), cost effectiveness, pain, and discomfort. METHODS A systematic literature search was conducted using PubMed, Cochrane Library, Google Scholar, Embase, and available clinical practice guidelines and was limited to systematic reviews/meta-analysis and clinical studies (randomized trials, cohort and case-control studies) published in English between 2000 and 2020. A narrative synthesis was performed, comparing HCIC with non-hydrophilic catheters in each pathology. The articles where critically appraised and weighted according to their level of evidence based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence grading. RESULTS Thirty seven original articles and 40 reviews were included. The comparison of HCICs versus non-hydrophilic catheters was well-documented in patients with mixed pathology, SCI, and to some extent SB. The available evidence predominantly indicates better outcomes with HCICs as reported by study authors, particularly, greater UTI reduction and improved satisfaction, cost-effectiveness, and QoL. However, SB studies in children did not report reduction in UTIs. Children complained about slippery catheters, indicating possible touching of the surface during insertion, which may compromise cleanliness of the procedure and affect outcomes such as UTI. Limited studies were available exclusively on BPH and none on MS; however, most studies performed on mixed pathologies, including BPH and MS, indicated strong preference for HCICs compared to non-hydrophilic catheters. CONCLUSIONS The findings generally support HCICs over non-hydrophilic catheters; however, most studies were fairly small, often used a mix of pathologies, and the conclusions were often based on studies with high drop-out rates that were therefore underpowered. Larger studies are needed to support the general finding that HCICs are the preferred choice in most populations. Additional training in children or redesigned catheters may be necessary for this age-group to fully benefit from the advantages of HCICs.
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Prieto JA, Murphy CL, Stewart F, Fader M. Intermittent catheter techniques, strategies and designs for managing long-term bladder conditions. Cochrane Database Syst Rev 2021; 10:CD006008. [PMID: 34699062 PMCID: PMC8547544 DOI: 10.1002/14651858.cd006008.pub5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intermittent catheterisation (IC) is a commonly recommended procedure for people with incomplete bladder emptying. Frequent complications are urinary tract infection (UTI), urethral trauma and discomfort during catheter use. Despite the many designs of intermittent catheter, including different lengths, materials and coatings, it is unclear which catheter techniques, strategies or designs affect the incidence of UTI and other complications, measures of satisfaction/quality of life and cost-effectiveness. This is an update of a Cochrane Review first published in 2007. OBJECTIVES: To assess the clinical and cost-effectiveness of different catheterisation techniques, strategies and catheter designs, and their impact, on UTI and other complications, and measures of satisfaction/quality of life among adults and children whose long-term bladder condition is managed by intermittent catheterisation. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 12 April 2021), the reference lists of relevant articles and conference proceedings, and we attempted to contact other investigators for unpublished data or for clarification. SELECTION CRITERIA Randomised controlled trials (RCTs) or randomised cross-over trials comparing at least two different catheterisation techniques, strategies or catheter designs. DATA COLLECTION AND ANALYSIS As per standard Cochrane methodological procedures, two review authors independently extracted data, assessed risk of bias and assessed the certainty of evidence using GRADE. Outcomes included the number of people with symptomatic urinary tract infections, complications such as urethral trauma/bleeding, comfort and ease of use of catheters, participant satisfaction and preference, quality of life measures and economic outcomes. MAIN RESULTS We included 23 trials (1339 randomised participants), including twelve RCTs and eleven cross-over trials. Most were small (fewer than 60 participants completed), although three trials had more than 100 participants. Length of follow-up ranged from one month to 12 months and there was considerable variation in definitions of UTI. Most of the data from cross-over trials were not presented in a useable form for this review. Risk of bias was unclear in many domains due to insufficient information in the trial reports and several trials were judged to have a high risk of performance bias due to lack of blinding and a high risk of attrition bias. The certainty of evidence was downgraded for risk of bias, and imprecision due to low numbers of participants. Aseptic versus clean technique We are uncertain if there is any difference between aseptic and clean techniques in the risk of symptomatic UTI because the evidence is low-certainty and the 95% confidence interval (CI) is consistent with possible benefit and possible harm (RR 1.20 95% CI 0.54 to 2.66; one study; 36 participants). We identified no data relating to the risk of adverse events comparing aseptic and clean techniques or participant satisfaction or preference. Single-use (sterile) catheter versus multiple-use (clean) We are uncertain if there is any difference between single-use and multiple-use catheters in terms of the risk of symptomatic UTI because the certainty of evidence is low and the 95% CI is consistent with possible benefit and possible harm (RR 0.98, 95% CI 0.55, 1.74; two studies; 97 participants). One study comparing single-use catheters to multiple-use catheters reported zero adverse events in either group; no other adverse event data were reported for this comparison. We identified no data for participant satisfaction or preference. Hydrophilic-coated catheters versus uncoated catheters We are uncertain if there is any difference between hydrophilic and uncoated catheters in terms of the number of people with symptomatic UTI because the certainty of evidence is low and the 95% CI is consistent with possible benefit and possible harm (RR 0.89, 95% CI 0.69 to 1.14; two studies; 98 participants). Uncoated catheters probably slightly reduce the risk of urethral trauma and bleeding compared to hydrophilic-coated catheters (RR 1.37, 95% CI 1.01 to 1.87; moderate-certainty evidence). The evidence is uncertain if hydrophilic-coated catheters compared with uncoated catheters has any effect on participant satisfaction measured on a 0-10 scale (MD 0.7 higher, 95% CI 0.19 to 1.21; very low-certainty evidence; one study; 114 participants). Due to the paucity of data, we could not assess the certainty of evidence relating to participant preference (one cross-over trial of 29 participants reported greater preference for a hydrophilic-coated catheter (19/29) compared to an uncoated catheter (10/29)). AUTHORS' CONCLUSIONS: Despite a total of 23 trials, the paucity of useable data and uncertainty of the evidence means that it remains unclear whether the incidence of UTI or other complications is affected by use of aseptic or clean technique, single (sterile) or multiple-use (clean) catheters, coated or uncoated catheters or different catheter lengths. The current research evidence is uncertain and design and reporting issues are significant. More well-designed trials are needed. Such trials should include analysis of cost-effectiveness because there are likely to be substantial differences associated with the use of different catheterisation techniques and strategies, and catheter designs.
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Affiliation(s)
- Jacqui A Prieto
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | - Fiona Stewart
- c/o Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mandy Fader
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Abstract
OBJECTIVE To evaluate the cost-effectiveness of surgical treatment pathways for apical prolapse. STUDY DESIGN We constructed a stochastic Markov model to assess the cost-effectiveness of vaginal apical suspension, laparoscopic sacrocolpopexy, and robotic sacrocolpopexy. We modeled over 5 and 10 years, with 9 pathways accounting for up to 2 separate surgical repairs, recurrence of symptomatic apical prolapse, reoperation, and complications, including mesh excision. We calculated costs from the health care system's perspective. RESULTS Over 5 years, compared with expectant management, all surgical treatment pathways cost less than the willingness-to-pay threshold of US $50,000 per quality adjusted life-years. However, among surgical treatments, all but 2 pathways were dominated. Of the remaining 2, laparoscopic sacrocolpopexy followed by vaginal repair for apical recurrence was not cost-effective compared with the vaginal-only approach (incremental cost-effectiveness ratio [ICER], >$500,000). Over 10 years, all but the same 2 pathways were dominated. However, starting with the laparoscopic approach in this case was more cost-effective with an ICER of US $6,176. If the laparoscopic approach was not available, starting with the robotic approach similarly became more cost-effective at 10 years (ICER, US $35,479). CONCLUSIONS All minimally invasive surgical approaches for apical prolapse repair are cost-effective when compared with expectant management. Among surgical treatments, the vaginal-only approach is the only cost-effective option over 5 years. However, over a longer period, starting with a laparoscopic (or robotic) approach becomes cost-effective. These results help inform discussions regarding the surgical approach for prolapse.
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Xi M, Elterman DS, Welk B, Pakosh M, Chan BCF. Cost‐effectiveness of hydrophilic‐coated urinary catheters for individuals with spinal cord injury: A systematic review. BJUI COMPASS 2020; 2:71-81. [PMID: 35474888 PMCID: PMC8988762 DOI: 10.1002/bco2.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 11/09/2022] Open
Abstract
Objective To identify and critically evaluate the economic evaluations examining the cost‐effectiveness of hydrophilic‐coated vs uncoated catheters for individuals with spinal cord injury. Methods We searched MEDLINE, the Excerpta Medica database (EMBASE), Cochrane Database of Systematic Reviews, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Emcare for studies in English and French. There were no restrictions to the year of publication. Our search strategy included the following key terms: “spinal cord injury,” “catheterization,” and “cost analysis.” Results The search identified 371 studies, of which eight studies met the inclusion criteria. Five studies observed hydrophilic‐coated catheters to be cost‐effective compared to uncoated catheters. Two studies found hydrophilic‐coated catheters to be not cost‐effective compared to uncoated catheters and one study estimated that hydrophilic‐coated catheters reduced the long‐term health‐care costs compared to uncoated catheters. Conclusion The cost‐effectiveness of hydrophilic‐coated catheters was dependent on the comparator used, the consideration of long‐term effects, and the unit cost of treatment. Further studies are needed to explore the short‐term and long‐term effects of hydrophilic‐coated catheter use on urinary tract infections and clarify the impact of hydrophilic‐coated catheter use on long‐term renal function. Overall, our critical evaluation of the literature suggests that the evidence is pointing toward hydrophilic‐coated catheters being cost‐effective, particularly when a societal perspective is applied.
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Affiliation(s)
- Min Xi
- KITE ‐ Toronto Rehabilitation Institute University Health Network Toronto ON Canada
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto ON Canada
| | - Dean S. Elterman
- Division of Urology Department of Surgery University Health Network Toronto ON Canada
| | - Blayne Welk
- Department of Surgery Western University London ON Canada
| | - Maureen Pakosh
- Library & Information Services University Health NetworkToronto Rehabilitation Institute Toronto ON Canada
| | - Brian C. F. Chan
- KITE ‐ Toronto Rehabilitation Institute University Health Network Toronto ON Canada
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto ON Canada
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Campeau L, Shamout S, Baverstock RJ, Carlson KV, Elterman DS, Hickling DR, Steele SS, Welk B. Canadian Urological Association Best Practice Report: Catheter use. Can Urol Assoc J 2020; 14:E281-E289. [PMID: 32432528 DOI: 10.5489/cuaj.6697] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Lysanne Campeau
- Division of Urology, Department of Surgery, Montreal Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Samer Shamout
- Division of Urology, Department of Surgery, Montreal Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Richard J Baverstock
- vesia [Alberta Bladder Centre] and Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Kevin V Carlson
- vesia [Alberta Bladder Centre] and Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Dean S Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Duane R Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Blayne Welk
- Division of Urology, Department of Surgery, University of Western Ontario, London, ON, Canada
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Sekido N, Igawa Y, Kakizaki H, Kitta T, Sengoku A, Takahashi S, Takahashi R, Tanaka K, Namima T, Honda M, Mitsui T, Yamanishi T, Watanabe T. Clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury. Int J Urol 2020; 27:276-288. [PMID: 32077161 DOI: 10.1111/iju.14186] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/23/2019] [Indexed: 12/16/2022]
Abstract
The present article is an abridged English translation of the Japanese clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury updated as of July 2019. The patients are adult spinal cord injured patients with lower urinary tract dysfunction; special consideration of pediatric and elderly populations is presented separately. The target audience is healthcare providers who are engaged in the medical care of patients with spinal cord injury. The mandatory assessment includes medical history, physical examination, frequency-volume chart, urinalysis, blood chemistry, transabdominal ultrasonography, measurement of post-void residual urine, uroflowmetry and video-urodynamic study. Optional assessments include questionnaires on the quality of life, renal scintigraphy and cystourethroscopy. The presence or absence of risk factors for renal damage and symptomatic urinary tract infection affects urinary management, as well as pharmacological treatments. Further treatment is recommended if the maximum conservative treatment fails to improve or prevent renal damage and symptomatic urinary tract infection. In addition, management of urinary incontinence should be considered individually in patients with risk factors for urinary incontinence and decreased quality of life.
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Affiliation(s)
- Noritoshi Sekido
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Urology, Nagano Prefectural Shinshu Medical Center, Suzaka, Nagano, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Graduate School of Medical Science, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Atsushi Sengoku
- Department of Urology, Hyogo Prefectural Rehabilitation Central Hospital, Kobe, Hyogo, Japan
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Ryosuke Takahashi
- Department of Urology, Spinal Injuries Center, Iizuka, Fukuoka, Japan
| | - Katsuyuki Tanaka
- Department of Urology, Kanagawa Rehabilitation Hospital, Atsugi, Kanagawa, Japan
| | - Takashige Namima
- Department of Urology, Tohoku Rosai Hospital, Sendai, Miyagi, Japan
| | - Masashi Honda
- Division of Urology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Takahiko Mitsui
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Chuo, Yamanashi, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Toyohiko Watanabe
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Saadat SH, Shepherd S, Van Asseldonk B, Elterman DS. Clean intermittent catheterization: Single use vs. reuse. Can Urol Assoc J 2019; 13:64-69. [PMID: 30138101 PMCID: PMC6363567 DOI: 10.5489/cuaj.5357] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intermittent catheterization (IC) is one of the fundamental aspects of managing patients with chronic urinary retention. Although reuse of catheters has been allowed to be chosen as the first option for IC, the optimal method of IC and the type of catheter has been a long-standing debate. We conducted a literature review regarding risk of urinary tract infection (UTI) and the costs associated with different methods and catheters. METHODS A MEDLINE search via PubMed, EMBASE, and EBSCO host was conducted in March 2018. The date of publication was limited to 2014 to present/current. RESULTS Single use of catheters (hydrophilic-coated [HC] or uncoated [UC]) was considered to impose a lower risk of UTI in all studies, except in one study that included children, but did not test their dexterity to handle HC catheters. Cost-effectiveness of single-use catheters was confirmed by all studies during this period. CONCLUSIONS Reuse of catheters exposes the patient to a plethora of possible cleaning techniques and duration of catheter use. Patient adherence to cleaning method cannot be predicted and this further amplifies the risk of complications and their burden on the healthcare system. We recommend a patient-centred approach to consider HC catheters as the first option, while considering the patient's/caregiver's ability to accommodate the usage technique. Single-use UC catheters, and finally reuse of catheters are considered as next options if HC catheters are found difficult to handle (especially in children doing self-catheterization). Larger trials investigating this matter are required.
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Affiliation(s)
- Seyed Hossein Saadat
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Shaun Shepherd
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | | | - Dean S. Elterman
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
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Welk B, Isaranuwatchai W, Krassioukov A, Husted Torp L, Elterman D. Cost-effectiveness of hydrophilic-coated intermittent catheters compared with uncoated catheters in Canada: a public payer perspective. J Med Econ 2018; 21:639-648. [PMID: 29458282 DOI: 10.1080/13696998.2018.1443112] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
STUDY DESIGN A Markov model was used to analyze cost-effectiveness over a lifetime horizon. OBJECTIVE To investigate the cost-effectiveness of hydrophilic-coated intermittent catheters (HCICs) compared with uncoated catheters (UCs) among individuals with neurogenic bladder dysfunction (NB) due to spinal cord injury (SCI). SETTING A Canadian public payer perspective based on data from Ontario; including a scenario analysis from the societal perspective. METHODS A previously published Markov decision model was modified to compare the lifetime costs and quality-adjusted life years (QALYs) for the two interventions. Three renal function and three urinary tract infection (UTI) health states as well as other catheter-related events were included. Scenario analyses, including utility gain from compact catheter and phthalate free catheter use, were performed. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the model. RESULTS The model predicted that a 50-year-old patient with SCI would gain an additional 0.72 QALYs if HCICs were used instead of UCs at an incremental cost of $48,016, leading to an incremental cost-effectiveness ratio (ICER) of $66,634/QALY. Moreover, using HCICs could reduce the lifetime number of UTI events by 11%. From the societal perspective, HCICs cost less than UCs, while providing superior outcomes in terms of QALYs, life years gained (LYG), and UTIs. The cost per QALY further decreased when health-related quality-of-life (HRQoL) gains associated with compact HCICs or catheters not containing phthalates were included. CONCLUSION In general, ICERs in the range of CAD$50-100,000 could be considered cost-effective. The ICERs for the base case and sensitivity analyses suggest that HCICs could be cost-effective. From the societal perspective, HCICs were associated with potential cost savings in our model. The results suggest that reimbursement of HCICs should be considered in these settings.
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Affiliation(s)
- Blayne Welk
- a Department of Surgery and Epidemiology & Biostatistics , Western University , London , Ontario , Canada
- b St Joseph's Health Care , London , Ontario , Canada
| | - Wanrudee Isaranuwatchai
- c Center for Excellence in Economic Analysis Research (CLEAR), The HUB, Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Ontario , Canada
- d Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto , Ontario , Canada
- e Canadian Center for Applied Research in Cancer Control , Vancouver , British Columbia , Canada
| | - Andrei Krassioukov
- f ICORD, Spinal Cord Program, GF Strong Rehabilitation Center, University of British Columbia , Vancouver , British Columbia , Canada
| | | | - Dean Elterman
- h Toronto Western Hospital/Krembil Research Institute , Toronto , Ontario
- i Department of Surgery , University of Toronto , Toronto , Ontario
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Truzzi JC, Teich V, Pepe C. Can hydrophilic coated catheters be beneficial for the public healthcare system in Brazil? - A cost-effectiveness analysis in patients with spinal cord injuries. Int Braz J Urol 2018; 44:121-131. [PMID: 28792195 PMCID: PMC5815542 DOI: 10.1590/s1677-5538.ibju.2017.0221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/17/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Detrusor sphincter dyssynergia affects 70% to 80% of all spinal cord injury patients, resulting in increased risk of urinary tract infections (UTIs) and potential exposure to antimicrobial resistance. In Brazil, local guidelines recommend intermittent catheterization as the best method for bladder emptying, and two catheter types are available: the conventional uncoated PVC and the hydrophilic coated catheters. OBJECTIVE To evaluate the cost-effectiveness of two types of catheters for intermittent catheterization from the perspective of the Brazilian public healthcare system. MATERIALS AND METHODS A Markov model was used to evaluate cost-effectiveness in those with spinal cord injuries. A primary analysis was conducted on all possible adverse events, and a secondary analysis was performed with urinary tract infections as the only relevant parameter. The results were presented as cost per life years gained (LYG), per quality-adjusted life years (QALY) and per number of urinary tract infections (UTIs) avoided. RESULTS The base scenario of all adverse events shows a cost-effective result of hydrophilic coated catheters compared to uncoated PVC catheters at 57,432 BRL (Brazilian Reais) per LYG and 122,330 BRL per QALY. The secondary scenario showed that the use of hydrophilic coated catheters reduces the total number of UTIs, indicating that an additional cost of hydrophilic coated catheters of 31,240 BRL over a lifetime will reduce lifetime UTIs by 6%. CONCLUSIONS Despite the higher unit value, the use of hydrophilic coated catheters is a cost-effective treatment from the perspective of the Brazilian public healthcare system.
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Affiliation(s)
- José Carlos Truzzi
- Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brasil
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
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