Epidemiology and health-economic burden of urinary catheter-associated infection in English NHS hospitals: a probabilistic modelling study

Summary Background Catheter-associated urinary tract infection (CAUTI) and bloodstream infection (CABSI) are leading causes of healthcare-associated infection in England’s National Health Service (NHS), but health-economic evidence to inform investment in prevention is lacking. Aims To quantify the health-economic burden and value of prevention of urinary catheter-associated infection among adult inpatients admitted to NHS Trusts in 2016/17. Methods A decision-analytic model was developed to estimate annual prevalence of CAUTI and CABSI, and their associated excess health burdens (quality-adjusted life-years, QALYs) and economic costs (£ 2017). Patient-level datasets and literature were synthesised to estimate population structure, model parameters and associated uncertainty. Health and economic benefits of catheter prevention were estimated. Scenario and probabilistic sensitivity analyses were conducted. Findings The model estimated 52,085 (95% uncertainty interval: 42,967–61,360) CAUTIs and 7,529 (6,857–8,622) CABSIs, of which 38,084 (30,236–46,541) and 2,524 (2,319–2,956) were hospital-onset infections, respectively. Catheter-associated infections incurred 45,717 (18,115–74,662) excess bed-days, 1,467 (1,337–1,707) deaths and 10,471 (4,783–13,499) lost QALYs. Total direct hospital costs were estimated at £54.4M (£37.3M–£77.8M), with an additional £209.4M (£95.7M–£270.0M) in economic value of QALYs lost assuming a willingness-to-pay threshold of £20,000/QALY. Respectively, CABSI accounted for 47% (32%–67%) and 97% (93%–98%) of direct costs and QALYs lost. Every catheter prevented could save £30 (£20–£44) in direct hospital costs and £112 (£52–£146) in QALY value. Conclusions Hospital catheter prevention is poised to reap substantial health-economic gains, but community-oriented interventions are needed to target the large burden imposed by community-onset infection.