Evidence map›Paper›PMID 29799871›Full record

Trial reportPloS one2018

Cost-effectiveness analysis of chlorhexidine-alcohol versus povidone iodine-alcohol solution in the prevention of intravascular-catheter-related bloodstream infections in France.

Franck Maunoury, Christian Farinetto, Stéphane Ruckly, Jeremy Guenezan, Jean-Christophe Lucet, Alain Lepape, Julien Pascal, Bertrand Souweine, Olivier Mimoz, Jean-François Timsit

Registry-linked trialOpen access · goldAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
In one paragraph

Trial report in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01629550 (Prospective Randomized Controlled Multicenter Trial of 4 Antiseptic Strategies for Prevention of Catheter Infection in Intensive Care Unit for Adults Patients), which is not on this map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
1.7field-weighted citation impact, top 16% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01629550 phase4completednot on this map

Prospective Randomized Controlled Multicenter Trial of 4 Antiseptic Strategies for Prevention of Catheter Infection in Intensive Care Unit for Adults Patients

TypeinterventionalSponsorPoitiers University HospitalRan2012Enrolled2,400ConditionsPreventing Catheter Related InfectionArmsskin disinfection prior catheter insertion
3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Observational
  5. Article
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 8 institutions in 1 country.

Franck MaunouryStatesia, Le Mans, France.ORCID 0000-0003-1045-4666
Christian FarinettoStatesia, Le Mans, France.
Stéphane RucklyICURE Search, Outcomerea, Paris, France.
Jeremy GuenezanUniversity Hospital of Poitiers, Emergency Department and Pre-Hospital Care, Poitiers, France.
Jean-Christophe LucetInfection Control Unit, AP-HP, Bichat University Hospital, Paris, France.
Alain LepapeDepartment of Anaesthesiology and Critical Care Medicine, University Hospital of Lyon-Sud, Lyon, France.
Julien PascalAdults Intensive Care Unit, Ongoing Monitoring Unit, Clermont Ferrand University Hospital, Clermont-Ferrand, France.
Bertrand SouweineIntensive Care Unit, Clermont Ferrand University Hospital, Clermont-Ferrand, France.
Olivier MimozUniversity Hospital of Poitiers, Emergency Department and Pre-Hospital Care, Poitiers, France.
Jean-François TimsitParis Diderot University - Bichat University hospital - Medical and Infectious Diseases Intensive care unit, Paris, France.
Centre Hospitalier Universitaire de Poitiers · FRCentre Hospitalier Universitaire de Clermont-Ferrand · FRDélégation Paris 7 · FRHospices Civils de Lyon · FRLaboratoire de Probabilités et Modèles Aléatoires · FRLe Mans Université · FRUniversité Claude Bernard Lyon 1 · FRUniversité Clermont Auvergne · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo perform a cost-effectiveness analysis of skin antiseptic solutions (chlorhexidine-alcohol (CHG) versus povidone iodine-alcohol solution (PVI)) for the prevention of intravascular-catheter-related bloodstream infections (CRBSI) in intensive care unit (ICU) in France based on an open-label, multicentre, randomised, controlled trial (CLEAN).

designA 100-day time semi-markovian model was performed to be fitted to longitudinal individual patient data from CLEAN database. This model includes eight health states and probabilistic sensitivity analyses on cost and effectiveness were performed. Costs of intensive care unit stay are based on a French multicentre study and the cost-effectiveness criterion is the cost per patient with catheter-related bloodstream infection avoided. PATIENTS: 2,349 patients (age≥18 years) were analyzed to compare the 1-time CHG group (CHG-T1, 588 patients), the 4-time CHG group (CHG-T4, 580 patients), the 1-time PVI group (PVI-T1, 587 patients), and the 4-time PVI group (PVI-T4, 594 patients).

intervention2% chlorhexidine-70% isopropyl alcohol (chlorhexidine-alcohol) compared to 5% povidone iodine-69% ethanol (povidone iodine-alcohol).

resultsThe mean cost per alive, discharged or dead patient was of €23,798 (95% confidence interval: €20,584; €34,331), €21,822 (€18,635; €29,701), €24,874 (€21,011; €31,678), and €24,201 (€20,507; €29,136) for CHG-T1, CHG-T4, PVI-T1, and PVI-T4, respectively. The mean number of patients with CRBSI per 1000 patients was of 3.49 (0.42; 12.57), 6.82 (1.86; 17.38), 26.04 (14.64; 42.58), and 23.05 (12.32; 39.09) for CHG-T1, CHG-T4, PVI-T1, and PVI-T4, respectively. In comparison to the 1-time PVI solution, the 1-time CHG solution avoids 22.55 CRBSI /1,000 patients, and saves €1,076 per patient. This saving is not statistically significant at a 0.05 level because of the overlap of 95% confidence intervals for mean costs per patient in each group. Conversely, the difference in effectiveness between the CHG-T1 solution and the PVI-T1 solution is statistically significant.

conclusionsThe CHG-T1 solution is more effective at the same cost than the PVI-T1 solution. CHG-T1, CHG-T4 and PVI-T4 solutions are statistically comparable for cost and effectiveness. This study is based on the data from the RCT from 11 French intensive care units registered with www.clinicaltrials.gov (NCT01629550).

Indexed as

2-PropanolAlcoholsBacteremiaCatheter-Related InfectionsChlorhexidineCost-Benefit AnalysisEthanolFemaleFranceFungemiaHumansIntensive Care UnitsLength of StayMaleModels, EconomicPovidone-Iodine2-PropanolAlcoholsChlorhexidineEthanolPovidone-Iodine

Identifiers

PMID29799871
PMCPMC5969756
OpenAlexW2804880049

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.