Cost-effectiveness of urinary dipsticks to screen asymptomatic catheter-associated urinary infections in an intensive care unit

• Published in: Intensive care medicine Vol. 27; no. 12; pp. 1842 - 1847
• Main Authors: TISSOT, Edgar, WORONOFF-LEMSI, Marie-Christine, CORNETTE, Christian, PLESIAT, Patrick, JACQUET, Micheline, CAPELLIER, Gilles
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.12.2001; Berlin Springer Nature B.V
• Subjects: Asymptomatic; Biological and medical sciences; Catheters; Cost analysis; Cost-Benefit Analysis; Cross Infection - etiology; Cross Infection - prevention & control; Cross Infection - urine; Female; France; Humans; Intensive care; Intensive Care Units - economics; Intubation; Investigative techniques, diagnostic techniques (general aspects); Leukocytes; Male; Mass Screening - economics; Medical sciences; Middle Aged; Miscellaneous. Technology; Nitrates; Organisms; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Patients; Prospective Studies; Reagent Strips - economics; Sensitivity and Specificity; Urinary Catheterization - adverse effects; Urinary tract diseases; Urinary tract infections; Urinary Tract Infections - etiology; Urinary Tract Infections - prevention & control; Urinary Tract Infections - urine; Urine; Urogenital system; France; Performance evaluation; Human; Nosocomial infection; Urinary system disease; Catheterization; Asymptomatic; Urinary tract disease; Urinary tract; Intensive care unit; Infection; Diagnosis; Technique; Cost efficiency analysis
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-001-1134-0

To assess the cost-effectiveness of urinary dipsticks (UDs) to screen asymptomatic catheterized patients for quantitative urine. Prospective comparison of UD with quantitative urine culture (QUC) (reference technique) and cost-effectiveness analysis performed from the hospital's perspective. Medical intensive care unit (ICU) of the Besançon University Hospital (France). All consecutive, asymptomatic, catheterized patients. Urinary dipsticks (Multistix 8-SG) were analyzed by the reflectance spectrophotometric method (Clinitek 50). Sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of four combinations of the leukocyte (L) test pad and the nitrite (N) test pad were calculated: L and N, L or N, L alone and N alone. A micro-costing technique was used to determine the direct medical cost of each strategy. The calculated cost-effectiveness ratio was the incremental cost-effectiveness (ICE) ratio. Three hundred thirty-nine urine samples taken from 144 patients were analyzed. The incidence of asymptomatic catheter-associated urinary tract infections (CAUTIs) was 31.3% (> or =10(5) organisms/ml). The L or N combination was the best detector of asymptomatic CAUTI: Se=87.2%, Sp=61.6%, PPV=30.6% and NPV=96.1%. The cost of QUC strategy and UD strategy was EUR 21.5 and EUR 12.6 per test, respectively. The ICE ratio of QUCs was EUR 69.5 per case of detected CAUTI. The UD is a cost-effective test for screening asymptomatic catheterized patients for quantitative urine culture in a medical ICU.