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Cost‐effectiveness of ethanol lock prophylaxis to prevent central line–associated bloodstream infections in children with intestinal failure in the United States
- Source :
- Journal of Parenteral and Enteral Nutrition. 46:324-329
- Publication Year :
- 2021
- Publisher :
- Wiley, 2021.
-
Abstract
- Introduction Central line-associated bloodstream infections (CLABSIs) lead to significant morbidity and mortality in children with intestinal failure (IF). Ethanol lock prophylaxis (ELP) greatly reduces CLABSI frequency with minimal side effects. However, in the United States, a recently approved orphan drug designation for dehydrated alcohol has greatly increased 70% ethanol cost from about $10/day to $1000/day. We examined the cost-effectiveness of ELP in relation to these changes. Methods We simulated a previously developed IF Markov model over 1 year. Costs were measured in 2020 US dollars and effectiveness in quality-adjusted life-years (QALYs). CLABSI rate with and without ELP was estimated from the largest available comparative observational study. The primary outcome was incremental cost-effectiveness ratio (ICER) between treatments. Secondary outcomes included CLABSI frequency. Sensitivity analyses on all model parameters were performed. Results In the base model, children with IF not using ELP accumulated $131,815 in costs and 0.32 QALYs per patient compared with $437,884 and 0.33 QALYs per patient in those using ELP. The ICER was nearly $17 million/QALY gained. ELP resulted in a 40% reduction in CLABSI frequency. ELP became cost-effective at $68/day and cost-saving at $63/day. Sensitivity analysis identified no other plausible parameter variation to reach the benchmark of $100,000/QALY gained. Conclusions At the current price, ELP is not cost-effective for CLABSI prevention in children with IF in the United States. This study highlights the critical need for the approval of an affordable lock therapy option to prevent CLABSIs in these children.
- Subjects :
- medicine.medical_specialty
Current price
030309 nutrition & dietetics
Cost effectiveness
Cost-Benefit Analysis
Medicine (miscellaneous)
Intestinal Failure
Orphan drug
03 medical and health sciences
0302 clinical medicine
Primary outcome
Sepsis
Intestinal failure
Humans
Medicine
Ethanol lock
Child
health care economics and organizations
0303 health sciences
Central line
Nutrition and Dietetics
Ethanol
business.industry
United States
Emergency medicine
030211 gastroenterology & hepatology
Observational study
Quality-Adjusted Life Years
business
Subjects
Details
- ISSN :
- 19412444 and 01486071
- Volume :
- 46
- Database :
- OpenAIRE
- Journal :
- Journal of Parenteral and Enteral Nutrition
- Accession number :
- edsair.doi.dedup.....a7790a8b3a8fcac92e1224cbdd5925af