Vol. 44 (1): 121-131, January – February, 2018

doi: 10.1590/S1677-5538.IBJU.2017.0221

ORIGINAL ARTICLE
José Carlos Truzzi 1,2, Vanessa Teich 3, Camila Pepe 3
1 Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brasil; 2 Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil; 3 Sense Company, São Paulo, SP, Brasil

ABSTRACT

Introduction: Detrusor sphincter dyssynergia affects 70% to 80% of all spinal cord in­jury patients, resulting in increased risk of urinary tract infections (UTIs) and potential exposure to antimicrobial resistance. In Brazil, local guidelines recommend intermit­tent catheterization as the best method for bladder emptying, and two catheter types are available: the conventional uncoated PVC and the hydrophilic coated catheters.

Objective: To evaluate the cost-effectiveness of two types of catheters for intermittent catheterization from the perspective of the Brazilian public healthcare system.

Materials and Methods: A Markov model was used to evaluate cost-effectiveness in those with spinal cord injuries. A primary analysis was conducted on all possible ad­verse events, and a secondary analysis was performed with urinary tract infections as the only relevant parameter. The results were presented as cost per life years gained (LYG), per quality-adjusted life years (QALY) and per number of urinary tract infections (UTIs) avoided.

Results: The base scenario of all adverse events shows a cost-effective result of hydro­philic coated catheters compared to uncoated PVC catheters at 57,432 BRL (Brazilian Reais) per LYG and 122,330 BRL per QALY. The secondary scenario showed that the use of hydrophilic coated catheters reduces the total number of UTIs, indicating that an additional cost of hydrophilic coated catheters of 31,240 BRL over a lifetime will reduce lifetime UTIs by 6%.

Conclusions: Despite the higher unit value, the use of hydrophilic coated catheters is a cost-effective treatment from the perspective of the Brazilian public healthcare system.

Keywords: Cost-Benefit Analysis; Spinal Cord Injuries; Intermittent Urethral Catheterization; Urinary Tract Infections

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