Table 3:

Summary of economic evaluations for Quality Improvement (QI) interventions designed to prevent Catheter-Associated Urinary Tract Infections (CAUTI) as reported by original study authors

Author (Year)	Intervention	Setting	Design & Comparator	Estimated Catheter Days	Baseline CAUTI Rate	Effectiveness	Approach, Perspective, Year of Costs	Program Costs	CAUTI-related Costs	Incremental Net Cost	mQHES
Changes to Hospital CAUTI-Related Policies and Practices
Palmer 201947	Catheterization tray, training program	U.K., 3 community hospitals	UCBA, SQ	NR	13.3% of catheterized patients	IRR = 0.16	Cost analysis, hospital, 2014	£5,440 for 3 hospitals	NR	-£33,000 for 3 hospitals	87.5
Mitchell 201948,57	Routine use of chlorhexidine prior insertion	Australia, 3 community hospitals	Model, SQ	NR	4.55 / 1000 catheter-days	IRR = 0.06 (95% CI: 0.01 to 0.32)	Cost analysis, hospital, 2018	AUD$89,012 per 100,000 catheter-izations	NR	−AUD$387,909 per 100,000 catheter- izations	89.5
Cartwright 201841	Catheterization tray, training program	U.K., 2 academic hospitals	UCBA, SQ	14,586	102 CAUTI per 2 HPY	IRR = 0.21	Cost analysis, hospital, 2015	−£40,000 per 2 HPY	−£159,400 per 2 HPY	NR	72
Pashnik 201744	Nurse-led teaching and evaluation	U.S., 1 academic hospital	UCBA, SQ	49,359	1.3 / 1000 catheter-days	IRR = 0.70	Cost analysis, hospital, 2016	$100,000 PH over 1.75 yr	$6,834 per CAUTI (1o data)	NR	64.5
Anderson 201158	Checklists, audit & feedback for CLABSI, CAUTI, VAP, MRSA	U.S., 24 community hospitals (23 eligible)	UCBA, SQ	282,915	4.4 / 1000 catheter-days	IRR 0.50	Cost analysis, hospital, 2009	$20,000 to $40,000 PHPY	−$82,722 to −$159,902 PHPY	−$7.9 to −$15.4 million for 24 hospitals over 5 years	102
van den Broek 201135	Removal reminder, ultrasound	Netherlands, 2 academic & 8 community hospitals	Time series, SQ	15,820	12.6% of catheterized patients	IRR 1.01	Cost analysis, hospital, 2008	€2,638 per hospital plus −€5.37 per hospitalized patient	$0 (not effective)	NR	101
Saint 200537	Physician reminders re: catheters	U.S., 1 academic hospital	CBA, SQ	NR	NR	Time catheterized: ↓7.6% vs. ↑15.1%	Cost analysis, hospital, 2003	$53,200 PHPY	−$53,449 PHPY	−$249 PHPY	82
Antimicrobial Catheters
Pickard 201238	Silver alloy catheter	U.K., 24 academic & community hospitals	RCT, PTFE-coated catheter	20,596	12.6% of catheterized patients	RD = −0.1%, IRR = 0.99	Cost-effectiveness, health system, 2007	£5.38 per catheterized patient	£548 per CAUTI (1o data)	+£5.05 per catheterized patient	113
	Nitrofurazone catheter			19,992		RD = −2.1%, IRR = 0.84		£4.19 per catheterized patient		−£7.10 per catheterized patient
Rupp 200436	Silver alloy catheter	U.S., 1 academic hospital	UCBA, uncoated catheter	48,662	6.13 / 1000 catheter-days	IRR = 0.43	Cost analysis, hospital, 2002	$64,794 PHPY	−$71,118 to −$549,377 PHPY	−$5,811 to −$535,452 PHPY	95.5
Lai 200239	Silver alloy catheter	U.S., 1 academic hospital	UCBA, uncoated catheter	62,855	4.9 / 1000 patient-days	IRR = 0.55	Cost analysis, hospital, 1997	$120,000 PHPY	$1,214 per CAUTI (1o data)	−$142,315 PHPY	97
Karchmer 200043	Silver alloy catheter	U.S., 1 academic medical center	Randomized crossover, uncoated catheter	112,846	3.00 / 1000 patient-days	IRR = 0.79 (95% CI: 0.63 to 0.99)	Cost analysis, hospital, 1997	$107,225 PHPY	−$121,681 to −$680,518 PHPY	−$14,456 to −$573,293 PHPY	103
Saint 200042	Silver alloy catheter	Hypothetical cohort, 1 academic hospital	Model, uncoated catheter	11,410	30 / 1000 catheterized patients	IRR = 0.53	Cost analysis, payer, 1998	$5.30 per catheterized patient	$374–402 + ($2041*0.04) per CAUTI (1o data)	−$4.09 per catheterized patient	105.5
Both CAUTI-Related Policies & Practices and Antimicrobial Catheters
Quinn 201540	Silver alloy catheter, nurse-driven protocol	U.S., 1 community hospital	UCBA, SQ	35,461	4.95 / 1000 catheter-days	IRR 0.08 (2012)	Cost analysis, hospital, 2009	$75,000 PHPY	$132,000 vs. $6,000 (2012) PHPY	NR	87
Clarke 201359	Silver alloy catheter, reminders, education	U.S, 1 community hospital	UCBA, SQ	5,821	5.2 / 1000 catheter-days	IRR 0.29	Cost analysis, Hospital, 2008	$23,924 PHPY	$1200 to $4700 per CAUTI (literature)	−$6,892 to −$96,772 PHPY	77

^*Abbreviations: mQHES, Quality of Health Economics Studies Checklist; CAUTI, catheter-associated urinary tract infection; QI, quality improvement; U.S., United States; U.K., United Kingdom; SQ, status quo (usual care); RR, rate ratio; IRR, incidence rate ratio; RD, risk difference; CEA, cost-effectiveness, cost-benefit, and related analyses; RCT, randomized control trial; UCBA, uncontrolled before-after analysis; CBA, controlled before-after analysis; NR, not reported; PTFE, polytetrafluoroethylene; PHPY, per hospital per year