Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection

JAMA. 1999 Aug 11;282(6):554-60. doi: 10.1001/jama.282.6.554.


Context: A recent randomized controlled trial and meta-analysis indicated that central venous catheters impregnated with an antiseptic combination of chlorhexidine and silver sulfadiazine are efficacious in reducing the incidence of catheter-related bloodstream infection (CR-BSI); however, the ultimate clinical and economic consequences of their use have not been formally evaluated.

Objective: To estimate the incremental clinical and economic outcomes associated with the use of antiseptic-impregnated vs standard catheters.

Design: Decision analytic model using data from randomized controlled trials, meta-analyses, and case-control studies, as well as safety data from the US Food and Drug Administration.

Setting and patients: A hypothetical cohort of hospitalized patients at high risk for catheter-related infections (eg, patients in intensive care units, immunosuppressed patients, and patients receiving total parenteral nutrition) requiring use of a central venous catheter.

Intervention: Short-term use (2-10 days) of chlorhexidine-silver sulfadiazine-impregnated multilumen central venous catheters and nonimpregnated catheters.

Main outcome measures: Expected incidence of CR-BSI and death attributable to antiseptic-impregnated and standard catheter use; direct medical costs for both types of catheters.

Results: In the base-case analysis, use of antiseptic-impregnated catheters resulted in a decrease in the incidence of CR-BSI of 2.2% (5.2% for standard vs 3.0% for antiseptic-impregnated catheters), a decrease in the incidence of death of 0.33% (0.78% for standard vs 0.45% for antiseptic-impregnated), and a decrease in costs of $196 per catheter used ($532 for standard vs $336 for antiseptic-impregnated). The decrease in CR-BSI ranged from 1.2% to 3.4%, the decrease in death ranged from 0.09% to 0.78%, and the costs saved ranged from $68 to $391 in a multivariate sensitivity analysis.

Conclusion: Our analyses suggest that use of chlorhexidine-silver sulfadiazine-impregnated central venous catheters in patients at high risk for catheter-related infections reduces the incidence of CR-BSI and death and provides significant saving in costs. Use of these catheters should be considered as part of a comprehensive nosocomial infection control program.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-Infective Agents, Local / administration & dosage
  • Anti-Infective Agents, Local / economics*
  • Catheterization, Central Venous / adverse effects
  • Catheterization, Central Venous / economics*
  • Catheterization, Central Venous / instrumentation
  • Cost-Benefit Analysis
  • Decision Trees
  • Equipment Contamination
  • Humans
  • Outcome Assessment, Health Care
  • Probability
  • Sensitivity and Specificity
  • Sepsis / economics
  • Sepsis / epidemiology
  • Sepsis / etiology*
  • Sepsis / prevention & control*
  • United States


  • Anti-Infective Agents, Local