The potential clinical and economic benefits of silver alloy urinary catheters in preventing urinary tract infection

Arch Intern Med. 2000 Sep 25;160(17):2670-5. doi: 10.1001/archinte.160.17.2670.


Background: Catheter-associated urinary tract infection (UTI) is associated with increased morbidity, mortality, and costs. A recent meta-analysis concluded that silver alloy catheters reduce the incidence of UTI by 3-fold; however, clinicians must decide whether the efficacy of such catheters is worth the extra per unit cost of $5.30.

Objective: To assess the clinical and economic impact of using silver alloy urinary catheters in hospitalized patients.

Methods: The decision model, performed from the health care payer's perspective, evaluated a simulated cohort of 1000 hospitalized patients on general medical, surgical, urologic, and intensive care services requiring short-term urethral catheterization (2-10 days). We compared 2 catheterization strategies: silver alloy catheters and standard (noncoated) urinary catheters. Outcomes included the incidence of symptomatic UTI and bacteremia and direct medical costs.

Results: In the base-case analysis, use of silver-coated catheters led to a 47% relative decrease in the incidence of symptomatic UTI from 30 to 16 cases per 1000 patients (number needed to treat = 74) and a 44% relative decrease in the incidence of bacteremia from 4.5 to 2.5 cases per 1000 patients (number needed to treat = 500) compared with standard catheters. Use of silver alloy catheters resulted in estimated cost savings of $4.09 per patient compared with standard catheter use ($20.87 vs $16.78). In a multivariate sensitivity analysis using Monte Carlo simulation, silver-coated catheters provided clinical benefits over standard catheters in all cases and cost savings in 84% of cases.

Conclusions: Using silver alloy catheters in hospitalized patients requiring short-term urinary catheterization reduces the incidence of symptomatic UTI and bacteremia, and is likely to produce cost savings compared with standard catheters.

Publication types

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

MeSH terms

  • Alloys
  • Anti-Infective Agents / therapeutic use
  • Bacteremia / etiology
  • Cost-Benefit Analysis
  • Decision Making*
  • Decision Trees
  • Hospital Costs
  • Hospitalization / economics
  • Humans
  • Incidence
  • Monte Carlo Method
  • Multivariate Analysis
  • Outcome Assessment, Health Care
  • Risk
  • Sensitivity and Specificity
  • Silver*
  • United States
  • Urinary Catheterization / adverse effects*
  • Urinary Catheterization / economics*
  • Urinary Catheterization / instrumentation
  • Urinary Tract Infections / complications
  • Urinary Tract Infections / economics*
  • Urinary Tract Infections / etiology
  • Urinary Tract Infections / prevention & control*


  • Alloys
  • Anti-Infective Agents
  • Silver