The cost-effectiveness of strategies preventing late-onset infection in preterm infants

Objective: Developing a model to analyse the cost-effectiveness of interventions preventing late-onset infection (LOI) in preterm infants and applying it to the evaluation of Anti-Microbial Impregnated Peripherally Inserted Central Catheters (AM-PICCs) compared with standard PICCs (S-PICCs). Design: Model-based cost-effectiveness analysis, using data from the PREVAIL randomised controlled trial linked to routine healthcare data, supplemented with published literature. The model assumes that LOI increases the risk of neurodevelopmental impairment (NDI). Setting: Neonatal Intensive Care Units in the UK National Health Service (NHS). Patients: Infants born ≤32 weeks gestational age, requiring a 1 French gauge PICC. Interventions: AM-PICC and S-PICC. Main outcome measures: Life expectancy, quality-adjusted life years and healthcare costs over the infants’ expected lifetime. Results: Severe NDI reduces life expectancy by 14.79 (95% confidence interval (CI) 4.43; 26.68; undiscounted) years, 10.63 (95%CI 7.74; 14.02; discounted) QALYs, and costs £19,060 (95%CI £14,197; £24,70; discounted) to the NHS. If LOI causes NDI, the maximum acquisition price of an intervention reducing LOI risk by 5% is £120. AM-PICCs increase costs (£54.85 (95%CI £25.95; £89.12)) but have negligible impact on health outcomes (-0.01 (95%CI -0.09; 0.04) QALYs), compared with S-PICCs. The NHS can invest up to £2.4 million in research to confirm that AM-PICCs are not cost-effective. Conclusions: The model quantifies health losses and additional healthcare costs caused by NDI and LOI during neonatal care. Given these consequences, interventions preventing LOI, even by a small extent, can be cost-effective. AM-PICCs, being less effective and more costly than S-PICC, are not likely to be cost-effective.