Healthcare resource consumption for intermittent urinary catheterisation: cost-effectiveness of hydrophilic catheters and budget impact analyses

Objectives – This study presents a cost-effectiveness analysis comparing hydrophilic coated to uncoated catheters for patients performing urinary intermittent catheterisation. A national budget impact analysis is also included to evaluate the impact of intermittent catheterisation for management of bladder dysfunctions over a period of 5 years. Design – A Markov model (lifetime horizon, 1 year cycle length) was developed to project health outcomes (life years and quality-adjusted life years – QALYs) and economic consequences related to patients using hydrophilic coated or uncoated catheters. The model was populated with catheter-related clinical efficacy data retrieved from randomised controlled trials and quality-of-life data (utility weights) from the literature. Cost data (EUR, 2015) were estimated on the basis of healthcare resource consumption derived from an e-survey addressed to key opinion leaders in the field. Setting – Italian Healthcare Service perspective. Population – Patients with spinal cord injury performing intermittent urinary catheterisation in the home setting. Main outcome measures – Incremental cost-effectiveness and cost-utility ratios (ICER, ICUR) of hydrophilic coated vs. uncoated catheters and associated healthcare budget impact. Results – The base-case ICER and ICUR associated with hydrophilic coated catheters were €20,761 and €24,405, respectively. This implies that hydrophilic coated catheters are likely to be cost-effective in comparison to uncoated ones, as proposed Italian threshold values range between €25,000 and €66,400. Considering a market share at year 5 of 89% hydrophilic catheters and 11% uncoated catheters, the additional cost for Italy is approximately €12 million in the next 5 years (current market share scenario for year 0: 80% hydrophilic catheters, 20% uncoated catheters). Conclusions – Considered over a lifetime, hydrophilic coated catheters are potentially a cost-effective choice in comparison to uncoated ones. These findings can assist policymakers in evaluating intermittent catheterisation in patients with spinal cord injury.