Cost-Effectiveness Analysis of Chlorhexidine Gluconate Compared with Povidone-Iodine Solution for Catheter-Site Care in Siriraj Hospital, Thailand
Ratree Maenthaisong MS*, Nathorn Chaiyakunapruk PharmD, PhD*, Visanu Thamlikitkul MD**
Affiliation : *Department of Pharmacy Practice, Naresuan University, Pitsanuloak, Thailand, **Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
Background : Catheter-related bloodstream infections (CRBSI) are an important cause of patient morbidity,
mortality, and increased health care costs. Use of an antiseptic solution for skin disinfection at the catheter
insertion site helps prevent catheter-related infections. In Thailand, povidone-iodine solution is the most
commonly used agent for this purpose. However, the results of several studies including a meta-analysis
indicated that the use of chlorhexidine gluconate is more effective than the use of povidone-iodine as an
antiseptic for preventing CRBSI. This study evaluated the cost-effectiveness of chlorhexidine gluconate versus
povidone-iodine for catheter-site care using the Siriraj Hospital perspective.
Materials and Methods : We used a decision analytic modeling for estimating the cost-effectiveness of antiseptic
solutions. The CRBSI rate was obtained from the Center for Nosocomial Infection Control at Siriraj Hospital,
while the efficacy of cholorhexidine compared to povidone-idone was based on a meta-analysis. The cost of
managing infections was derived from the Thai Drug Related Group (DRG). A series of sensitivity analyses
were performed. Since the time horizon of the analysis was less than 1 year, there was no need for discounting.
Results : We found that the use of chlorhexidine, rather than povidone iodine, for central catheter site care
resulted in a 1.61 % decrease in the incidence of CRBSI, a 0.32 % decrease in the incidence of death, and
savings of 304 baht per catheter used. For peripheral catheter site care, the results were similar, although the
differences were smaller.
Conclusion : Use of chlorhexidine gluconate in place of the current standard solution for vascular catheter
site care is a cost-effective method of improving patient safety in Siriraj Hospital.
Keywords : Cost effectiveness, Chlorhexidine gluconate, Povidone-iodine, Catheter-related bloodstream in- fections
