EMPIRICAL ECONOMIC EVALUATION AND ENVIRONMENTAL IMPACT ASSESSMENT OF REUSABLE VERSUS SINGLE-USE CATHETERS FOR CLEAN INTERMITTENT CATHETERISATION
Author(s)
Habab M.A. Rahma, MSc1, Coen Christiaans, MD2, Elisabeth M. Smale, PhD2, Maureen Rutten-van Mölken, Sr., PhD3, Carin Uyl-De Groot, Sr., PhD4, Frederick W. Thielen, BSc, MSc, PhD5.
1HTA, Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, Netherlands, 2Erasmus MC, Rotterdam, Netherlands, 3Erasmus University, Rotterdam, Netherlands, 4ESHPM/iMTA Erasmus University Rotterdam, Rotterdam, Netherlands, 5Erasmus University Rotterdam, Rotterdam, Netherlands.
1HTA, Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, Netherlands, 2Erasmus MC, Rotterdam, Netherlands, 3Erasmus University, Rotterdam, Netherlands, 4ESHPM/iMTA Erasmus University Rotterdam, Rotterdam, Netherlands, 5Erasmus University Rotterdam, Rotterdam, Netherlands.
OBJECTIVES: From a whole health perspective, human and planetary health outcomes of healthcare interventions are relevant to decision-making, particularly for reusable and single-use medical devices. Patients with chronic urinary retention who require clean intermittent catheterisation (CIC) several times daily commonly use single-use catheters. We evaluated the 12-month cost-effectiveness and environmental impacts of reusable versus single-use catheters for CIC from a Dutch societal perspective.
METHODS: This analysis was based on the COMPaRE study in which 386 adults performing self-CIC were randomised to reusable or single-use catheterisation and followed for 12 months. Primary cost-effectiveness outcomes were societal costs and quality-adjusted life years (QALYs), while primary environmental outcomes were global warming potential (GWP) expressed as kg CO₂-eq per patient-year, and total system waste. Incremental costs and QALYs were estimated using seemingly unrelated regression, with predictive mean matching within 5,000 bootstrap replications. Environmental outcomes were quantified using a cradle-to-grave life cycle assessment. The base case assumed five catheterisations daily and 14-day reusable catheter replacement.
RESULTS: Mean societal costs were €11,656 for reusable versus €19,891 for single-use, a reduction of €8,235 per patient-year (95% CI: €3,027-€12,770), with comparable QALYs (difference 0.005; 95% CI: −0.016 to 0.026). Reusable catheters had a 99.3% probability of being cost-effective at a willingness-to-pay threshold of €20,000 per QALY gained. Preliminary environmental estimates showed that reusable catheters reduced GWP from 94.7 kg CO₂-eq per patient-year (95% CI: 94.54-94.90) to 11.3 kg CO₂-eq per patient-year (95% CI: 11.23-11.34), and total system waste from 42.0 to 3.9 kg, reductions of 88.1% and 90.7%, respectively.
CONCLUSIONS: Reusable catheterisation was cost-saving with comparable QALYs. Preliminary environmental findings support reusable catheters as a sustainable option for chronic CIC. However, lower follow-up completion in the reusable catheter group may indicate a trade-off between the economic and environmental benefits and patient acceptability of the burden associated with cleaning.
METHODS: This analysis was based on the COMPaRE study in which 386 adults performing self-CIC were randomised to reusable or single-use catheterisation and followed for 12 months. Primary cost-effectiveness outcomes were societal costs and quality-adjusted life years (QALYs), while primary environmental outcomes were global warming potential (GWP) expressed as kg CO₂-eq per patient-year, and total system waste. Incremental costs and QALYs were estimated using seemingly unrelated regression, with predictive mean matching within 5,000 bootstrap replications. Environmental outcomes were quantified using a cradle-to-grave life cycle assessment. The base case assumed five catheterisations daily and 14-day reusable catheter replacement.
RESULTS: Mean societal costs were €11,656 for reusable versus €19,891 for single-use, a reduction of €8,235 per patient-year (95% CI: €3,027-€12,770), with comparable QALYs (difference 0.005; 95% CI: −0.016 to 0.026). Reusable catheters had a 99.3% probability of being cost-effective at a willingness-to-pay threshold of €20,000 per QALY gained. Preliminary environmental estimates showed that reusable catheters reduced GWP from 94.7 kg CO₂-eq per patient-year (95% CI: 94.54-94.90) to 11.3 kg CO₂-eq per patient-year (95% CI: 11.23-11.34), and total system waste from 42.0 to 3.9 kg, reductions of 88.1% and 90.7%, respectively.
CONCLUSIONS: Reusable catheterisation was cost-saving with comparable QALYs. Preliminary environmental findings support reusable catheters as a sustainable option for chronic CIC. However, lower follow-up completion in the reusable catheter group may indicate a trade-off between the economic and environmental benefits and patient acceptability of the burden associated with cleaning.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
PT20
Topic
Economic Evaluation, Medical Technologies
Topic Subcategory
Novel & Social Elements of Value, Trial-Based Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Urinary/Kidney Disorders