The potential clinical and economic benefits of silver alloy urinary catheters in preventing urinary tract infection

Background: Catheter-associated urinary tract infection (UTI) is associated with increased morbidity, mortality, and costs. A recent meta-analysis con cluded that silver alloy catheters reduce the incidence of UTI by 3-fold; h owever, clinicians must decide whether the efficacy of such catheters is wo rth the extra per unit cost of $5.30. Objective: To assess the clinical and economic impact of using silver alloy urinary catheters in hospitalized patients. Methods: The decision model, performed from the health care payer's perspec tive, evaluated a simulated cohort of 1000 hospitalized patients on general medical, surgical, urologic, and intensive care services requiring shortte rm urethral catheterization (2-10 days). We compared 2 catheterization stra tegies: silver alloy catheters and standard (noncoated) urinary catheters. Outcomes included the incidence of symptomatic UTI and bacteremia and direc t medical costs. Results: In the base-case analysis, use of silver-coated catheters led to a 47% relative decrease in the incidence of symptomatic UTI from 30 to 16 ca ses per 1000 patients (number needed to treat=74) and a 44% relative decrea se in the incidence of bacteremia from 4.5 to 2.5 cases per 1000 patients ( number needed to treat=500) compared with standard catheters. Use of silver alloy catheters resulted in estimated cost savings of $4.09 per patient co mpared with standard catheter use ($20.87 vs $16.78). In a multivariate sen sitivity analysis using Monte Carlo simulation, silver-coated catheters pro vided clinical benefits over standard catheters in all cases and cost savin gs in 84% of cases. Conclusions: Using silver alloy catheters in hospitalized patients requirin g short-term urinary catheterization reduces the incidence of symptomatic U TI and bacteremia, and is likely to produce cost savings compared with stan dard catheters.