Can hydrophilic coated catheters be beneficial for the public healthcare system in Brazil? - A cost-effectiveness analysis in patients with spinal cord injuries

Abstract

IntroductionDetrusor 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.ObjectiveTo evaluate the cost-effectiveness of two types of catheters for intermittent catheterization from the perspective of the Brazilian public healthcare system.Materials and MethodsA 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.ResultsThe 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%.ConclusionsDespite the higher unit value, the use of hydrophilic coated catheters is a cost-effective treatment from the perspective of the Brazilian public healthcare system.

Intermittent Catheter Reimbursement in the United States: The Experience of Nine Stakeholders Through the Lens of Actor-Network Theory

“…These characteristics may provide a sanitary advantage over uncoated catheters to which the consumer (optionally) applies a lubricant. An increasing number of studies report a lower incidence of UTI in people using hydrophilic versus uncoated catheters (Clark et al, 2016;Rognoni & Tarricone, 2017;Truzzi, Teich, & Pepe, 2018;Watanabe et al, 2017;Welk, Isaranuwatchai, Krassioukov, Husted Torp, & Elterman, 2018). The more expensive-to-produce HC is coded the same, and reimbursed the same, as the less expensive uncoated straight IC, resulting in an impediment to access (See Table 3).…”

“…Those with NB whose access to catheters depend on reimbursement falling within the CMS payment schedule that fail to establish a higher rate for HCs effectively inhibits access to a demonstrably safer product. Further, there is a large amount of evidence showing the cost-effectiveness of HCs in the health systems of such countries as Brazil (Truzzi et al, 2018), Canada (Welk et al, 2018), Italy (Rognoni & Tarricone, 2017), and Japan (Watanabe et al, 2017) due to associated reduction in UTI burden. We could find no similar study in the US system and no data on the number of individuals who would switch to HCs if reimbursement coding expanded.…”

Cost‐effectiveness of hydrophilic‐coated urinary catheters for individuals with spinal cord injury: A systematic review

“…4,12,18,[24][25][26][27][28] Three studies also examined cost per life-year gained. 12,26,27 One study also examined cost per UTI avoided per patient. 25 Studies were conducted from the following perspectives:…”

“…national health-care system perspective (n = 5), 12,24,25,27,28 public payer perspective (n = 2), 4,18 and payer perspective (n = 1). 26 Six of the eight studies compared single-use hydrophilic-coated catheters to single-use uncoated catheters.…”

Editorial Comment: An Effective Evidence-Based Cleaning Method for the Safe Reuse of Intermittent Urinary Catheters: In Vitro Testing

“…Bacterial biofilm still represents an important barrier for patients who reuse catheters ( 5 ). A general limitation of most uncoated PVC catheters is that they contain softeners such as phthalates that may put the users at risk of certain diseases ( 6 ). In the general population, exposure to some phthalate diesters is a cause of increasing concern because of their potential adverse effects on the reproductive and endocrine systems ( 7 ).…”