Cost-effectiveness analysis of hydrophilic coated catheters for intermittent catheterisation in traumatic spinal cord injury in New Zealand.

BACKGROUND: Intermittent catheterisation is the standard treatment for incomplete bladder emptying in spinal cord injuries (SCI), but urinary tract infections (UTI) remain a common and costly complication. Hydrophilic-coated catheters have been shown to decrease infection rates; however, they are more expensive compared to uncoated catheters. The aim was to model the cost-effectiveness of hydrophilic-coated catheters (HCIC) compared to uncoated catheters in New Zealand (NZ) patients with traumatic SCI who intermittently catheterise.

METHODS: A probabilistic economic Markov model adapted to NZ costing and demographics modelled economic and quality-of-life benefits for the two catheter types in SCI patients using intermittent catheters. Inputs included UTI rates, severity of infection, utility values, SCI demographics, catheter costs and UTI treatment in New Zealand dollars. The model output reports UTI rates, life years gained, quality-adjusted life-years and incremental cost-effectiveness ratios for the two catheter types.

RESULTS: HCIC use is predicted to reduce UTIs by 11%, resulting in a 7% increase in quality adjusted life years (QALY). Over a patient's lifetime, it is estimated that 3.8 simple infections and 2.1 prolonged infections treated in primary care could be avoided, and it is predicted to avoid 1.3 severe complex infections that require hospitalization. The incremental cost-effectiveness ratio of $27 919/QALY falls within NZ Government willingness to pay threshold for therapeutic interventions.

CONCLUSION: Reducing UTI's with HCIC has quality of life and economic benefits to the patient and healthcare system, as it is a common and costly complication in New Zealand. This model demonstrates that HCIC is likely to be cost-effective in New Zealand SCI patients.