Cost-Effectiveness of a New Multi-Lumen Infusion Device to Reduce Central Venous Line-Related Infections in a Neonatal Intensive Care Unit

OBJECTIVES: Catheter-related infections are the main cause of late-onset sepsis in neonatal intensive care units (NICU). A new device, Edelvaiss Multiline® Neo, was recently proposed for multi-infusion in hospitalized neonates, to reduce catheter-related infections. As its front cost is higher than other available devices, our objective was to evaluate the cost-effectiveness of the strategy incorporating this new device.

METHODS: A single-center before-and-after, observational study was conducted in a NICU of a French university hospital to evaluate the cost and effectiveness of the new strategy. Before (Period 1= Year 2019, P1) and after (period 2= Year 2020, P2) its introduction, the costs were calculated and compared from the hospital perspective, and the incidence of late-onset sepsis was examined as effectiveness outcome. The time horizon was the period starting from admission to the NICU to NICU discharge. The consumption of infusion medical device, infection treating drugs and biological analysis was obtained from our local database, and valued using tariffs for year 2019. The incremental cost-effectiveness ratio (ICER), expressed as euros per infection avoided, was calculated. One-way and multivariate sensitivity analyses were used to evaluate the uncertainty.

RESULTS: The clinical characteristics of 609 infants selected in the study (n= 303 during P1 and n=306 during P2) were similar between the two periods. The incidence of catheter-related infections was significantly reduced (rate ratio: 0.22; IC95% [0.07-0.56], as were total costs (from €65,666 to €63,932 per 1000 catheter.days respectively), yielding to an ICER of 251 euros saved per infection avoided. The estimates were robust with the new strategy remaining economically dominant in the majority of scenarios of sensitivity analyses.

CONCLUSIONS: This pilot study showed a significant reduction in the incidence of catheter related infections without increase in costs. Further prospective multicenter randomized studies are needed to confirm these promising results.