OBJECTIVES

To develop a model to analyse the cost-effectiveness of interventions to prevent late-onset infection (LOI) in preterm infants and apply it to the evaluation of Anti-Microbial Impregnated Peripherally Inserted Central Catheters (AM-PICCs) compared with standard PICCs (S-PICCs).

METHODS

Model-based cost-effectiveness analysis, using data from the PREVAIL randomised controlled trial linked to routine healthcare data, and supplemented with published literature. The model assumes that LOI increases the risk of neurodevelopmental impairment (NDI) during an infant stay in a Neonatal Intensive Care Unit in the UK National Health Service (NHS). The analysis considers a population of Infants born ≤32 weeks gestational age, requiring a 1 French gauge PICC. The model estimates 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) years, 10.63 (95%CI 7.74; 14.02) QALYs, and costs £19,060 (95%CI £14,197; £24,70) to the NHS. If LOI causes NDI, the maximum acquisition price of an intervention that reduces LOI risk by 5% is £120. AM-PICCs increase costs (£54.85 (95%CI £25.95; £89.12)) and may reduce health (-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 that prevent 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.