Vancomycin flush as antibiotic prophylaxis for early catheter-related infections: a cost-effectiveness analysis

Early catheter-related infection (CRI) remains a severe complication in cancer patients. Some recent data suggest that vancomycin flush (VF) administered on the day of catheter insertion could reduce the CRI incidence, but VF could also induce infections by vancomycin-resistant Enterococcus sp. (VRE). So, we had conducted a decision model analysis of the cost and the effectiveness of three preventive strategies: absence of VF, VF in all cases, and VF in high-risk patients. The main outcome was absence of CRI and absence of VRE. Inputs were extracted from literature data. Variable uncertainty was explored by one- and two-way sensitivity analyses and best/worst case analysis. Model uncertainty was explored by Monte Carlo probabilistic sensitivity analysis. In base case, compared to absence of VF, the VF strategy in high-risk patients was the best strategy, in terms of cost (reduction cost estimated at $190 per patient) and benefit (probability of infection estimated at 98.1% versus 96.6%). The VF strategy in all cases was strongly dominated. These findings were confirmed by sensitivity analysis. VF in high-risk patients, such as defined in literature, is beneficial and cost-saving. Nevertheless, further investigations are needed to define better the probability and the cost of VRE, which are the two variables driving the model.