The Economic Impact of Indwelling Urinary Catheterization on Total Joint Arthroplasty Procedures and Implications for Urinary Catheter Alternatives: A Systematic Review, Analysis, and Model
Author(s)
Timothy Kelly, MBA, MSc1, Jun Li, PhD2, Mutsuo Yamazaki, PhD3, Hiroshi Kubo, MD, PhD3.
1Director HEOR, Becton Dickinson, Atlanta, GA, USA, 2Becton Dickinson Asia, Ltd., Beijing, China, 3Nippon Becton Dickinson Company, Ltd., Tokyo, Japan.
1Director HEOR, Becton Dickinson, Atlanta, GA, USA, 2Becton Dickinson Asia, Ltd., Beijing, China, 3Nippon Becton Dickinson Company, Ltd., Tokyo, Japan.
Presentation Documents
OBJECTIVES: Indwelling urinary catheters (IUCs) are commonly employed with patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) procedures. IUCs increase the risk of post-operative urinary tract infections (UTIs), which in turn, increase the risk of prosthetic joint infections (PJIs). With recent advances in IUC alternatives including bladder scanning, intermittent catheters, and external catheters; providers may benefit from estimating the potential reduction in UTIs that may result from avoidance of IUCs along with estimating the clinical and economic consequences of those infections.
METHODS: A systematic review of original research and meta-analyses published from 2000-2025 (PubMed) assessed the impact of IUCs upon the adverse effects associated with TKA and THA procedures. The results were analyzed and applied to a model to estimate the UTI and PJI economic burden avoided when patients are managed without IUCs.
RESULTS: 42 records were identified. After exclusions, 34 records were reviewed, and 7 were analyzed. The average rate of post-operative UTI in patients with IUCs was 3.7% (1.8%-6.2%) and 1.1% (0%-3.4%) in patients managed without IUCs. Applying a $6,101 cost of a hospital-onset UTI - a value not associated with extended length-of-stay, secondary bloodstream infection, or time in the ICU - the per-patient UTI cost avoidance of managing patients without IUCs was found to be $153. One analyzed study found that the incidence of PJIs declined 62% in patients managed without catheters instead of with IUCs. The mean 90-day revision rates due to PJI are 0.1% and 0.3% for TKA and THA, respectively, suggesting that an IUC avoidance strategy could eliminate 6 TKA revisions and 19 THA revisions for every 10,000 procedures, respectively.
CONCLUSIONS: IUCs are associated with higher postoperative UTI rates than those observed with patients managed with intermittent or no catheters. Modeling suggests that avoidance of IUCs may avoid costs associated with UTIs and PJIs.
METHODS: A systematic review of original research and meta-analyses published from 2000-2025 (PubMed) assessed the impact of IUCs upon the adverse effects associated with TKA and THA procedures. The results were analyzed and applied to a model to estimate the UTI and PJI economic burden avoided when patients are managed without IUCs.
RESULTS: 42 records were identified. After exclusions, 34 records were reviewed, and 7 were analyzed. The average rate of post-operative UTI in patients with IUCs was 3.7% (1.8%-6.2%) and 1.1% (0%-3.4%) in patients managed without IUCs. Applying a $6,101 cost of a hospital-onset UTI - a value not associated with extended length-of-stay, secondary bloodstream infection, or time in the ICU - the per-patient UTI cost avoidance of managing patients without IUCs was found to be $153. One analyzed study found that the incidence of PJIs declined 62% in patients managed without catheters instead of with IUCs. The mean 90-day revision rates due to PJI are 0.1% and 0.3% for TKA and THA, respectively, suggesting that an IUC avoidance strategy could eliminate 6 TKA revisions and 19 THA revisions for every 10,000 procedures, respectively.
CONCLUSIONS: IUCs are associated with higher postoperative UTI rates than those observed with patients managed with intermittent or no catheters. Modeling suggests that avoidance of IUCs may avoid costs associated with UTIs and PJIs.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE412
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Infectious Disease (non-vaccine), SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), SDC: Urinary/Kidney Disorders