Intermittent self catheterisation with hydrophilic, gel reservoir, and non-coated catheters: a systematic review and cost effectiveness analysis.
Intermittent self catheterisation with hydrophilic, gel reservoir, and non-coated catheters: a systematic review and cost effectiveness analysis.
复制标题
DOI：
10.1136/bmj.e8639
复制
发表时间：
2013-01-08
期刊：
影响因子：
--
通讯作者：
Pellowe C
中科院分区：
文献类型：
--
作者：
Bermingham SL;Hodgkinson S;Wright S;Hayter E;Spinks J;Pellowe C
目的探讨在社区进行间歇性自我导尿的患者最有效和最具成本效益的导尿管类型。设计系统综述和荟萃分析。结果被纳入概率马尔可夫模型，比较寿命成本和质量调整寿命年（QEARS）。数据来源我们检索了2002年至2011年4月18日的Medline、Embase、科克伦和Cinahl数据库，以识别比较亲水性、凝胶储液囊和无涂层间歇性导管的研究。早期的指南用于识别2002年之前发表的论文。为了获取比较清洁和无菌无涂层间歇性自我导管插入术的研究，对每个数据库进行了检索，检索日期从其成立之日到2011年4月18日。主要结局指标临床结局包括症状性尿路感染（UTI）、菌血症、死亡率、患者偏好或舒适度以及使用的导管数量。经济模型包括UTI的下游并发症，成本效益计算为每获得QALY的增量成本。结果共纳入8篇文献。大多数是在脊髓损伤患者中进行的，大多数纳入的患者是男性。与无菌无涂层导管相比，使用凝胶储液囊和亲水性导管的患者报告一个或多个UTI的可能性显著降低（凝胶储液囊的绝对效应=每1000例减少149例（95%置信区间-7至198），P=0.04;亲水性导管的绝对效应=每1000例减少153例（-8至268），P=0.04）。然而，当以平均每月UTI（平均差异= 0.01（-0.11至0.09），P=0.84）或1年时的总UTI（平均差异= 0.18（-0.50至0.86），P=0.60）测量结局时，亲水性和无菌无涂层导管之间没有差异。使用清洁导管与无菌无涂层导管的患者发生一次或多次尿路感染的发生率几乎没有差异（绝对效应=每1000例患者中减少12例（-134至146），P=0.86）。虽然最有效，但凝胶储液导管每获得一个QALY的成本>£54 350，因此与清洁的无涂层自我导管相比不具有成本效益。结论间歇性自我导尿所用导尿管的类型对症状性UTI的风险影响不大。鉴于资源使用的巨大差异，清洁的无涂层导管是最具成本效益的。然而，由于证据基础的局限性和差距以及将无涂层导管指定为一次性使用器械，我们建议应采用预防原则，并应向患者提供亲水性和凝胶储液囊导管之间的选择。
Objective To determine the most effective and cost effective type of catheter for patients performing intermittent self catheterisation in the community. Design Systematic review and meta-analysis. Results were incorporated into a probabilistic Markov model to compare lifetime costs and quality adjusted life years (QALYs). Data sources We searched Medline, Embase, and Cochrane and Cinahl databases from 2002 to 18 April 2011 to identify studies comparing hydrophilic, gel reservoir, and non-coated intermittent catheters. Earlier guidelines were used to identify papers published before 2002. To capture studies comparing clean and sterile non-coated intermittent self catheterisation, each database was searched from its date of inception to 18 April 2011. Main outcome measures Clinical outcomes included symptomatic urinary tract infection (UTI), bacteraemia, mortality, patient preference or comfort, and number of catheters used. The economic model included downstream complications of UTI and cost effectiveness was calculated as incremental cost per QALY gained. Results Eight studies were included in the systematic review. Most were conducted in patients with spinal cord injuries, and most of the included patients were men. People using gel reservoir and hydrophilic catheters were significantly less likely to report one or more UTIs compared with sterile non-coated catheters (absolute effect for gel reservoir = 149 fewer per 1000 (95% confidence interval −7 to 198), P=0.04; absolute effect for hydrophilic = 153 fewer per 1000 (−8 to 268), P=0.04). However, there was no difference between hydrophilic and sterile non-coated catheters when outcomes were measured as mean monthly UTIs (mean difference = 0.01 (−0.11 to 0.09), P=0.84) or total UTIs at 1 year (mean difference = 0.18 (−0.50 to 0.86), P=0.60). There was little difference in the incidence of one or more UTIs for people using clean versus sterile non-coated catheters (absolute effect = 12 fewer per 1000 (−134 to 146), P=0.86). Although the most effective, gel reservoir catheters cost >£54 350 per QALY gained and are therefore not cost effective compared with clean non-coated self catheterisation. Conclusion The type of catheter used for intermittent self catheterisation seems to make little difference to the risk of symptomatic UTI. Given large differences in resource use, clean non-coated catheters are most cost effective. However, because of limitations and gaps in the evidence base and the designation of non-coated catheters as single use devices, we recommend a precautionary principle should be adopted and that patients should be offered a choice between hydrophilic and gel reservoir catheters.