Widespread adoption of single-use intermittent catheters for bladder drainage has led to increased costs and environmental waste. Reusable catheters could reduce both. The MultICath study showed that combined reusable and single-use catheters (Mixed-use) was non-inferior to single-use catheters for urinary tract infection and quality of life, but the economic impact is unknown. We aim to determine whether Mixed-use is cost-effective compared to Single-use only.
Cost-utility and cost-consequence analyses were conducted alongside MultICath. The analysis took the United Kingdom payer perspective, using individual patient-level data of the 578 randomised (1:1) trial participants over 12 months. Costs included catheter and cleaning costs, antibiotic costs, and health-related visit costs. Outcomes were measured in quality adjusted life years (QALYs), estimated from EQ-5D-5L data. Incremental, sensitivity, and scenario analyses were conducted.
Mixed-use participants used on average 902 (95% CI 755.13; 1049.31) fewer single-use catheters per annum than Single-use participants. Mixed-use was cost-effective in all analyses. Base-case annual incremental cost savings were -£1348.82 (95% CI -1939.98; -757.65) whilst incremental QALYs were negligible (-0.001; [-0.026; 0.024]). These estimates produced a positive net monetary benefit of £1328.82 at a willingness-to-pay threshold of £20,000. The probability of Mixed-use being cost-effective was never below 96.6%. The primary limitation was differential withdrawal rates between groups, accounted for in sensitivity analyses.
Mixed-use is cost-effective for the UK National Health Service, and provision of reusable catheters should be considered. These findings are also relevant for other health services worldwide with high single-use catheter costs.
Cost effectiveness and resource allocation : C/E. 2026 May 09 [Epub ahead of print]
Sara McCloskey, Tracey H Sach, Margaret Macaulay, Miriam R Avery, Thomas J Chadwick, Bridget Clancy, Sylvia Dickson, Nicola Goudie, Karen Guerrero, Suzanne Hagen, Cathy Murphy, Gillian C Watson, Nina Wilson, Ruth Wood, Mandy Fader
School of Primary Care, Population Sciences and Medical Education, University of Southampton, University Road, Southampton, SO17 1BJ, UK., School of Primary Care, Population Sciences and Medical Education, University of Southampton, University Road, Southampton, SO17 1BJ, UK. ., School of Health Sciences, University of Southampton, University Road, Southampton, SO17 1BJ, UK., Newcastle Clinical Trials Unit, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK., Nurses, Midwives and Allied Health Professionals Research Unit, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK., Department of Urogynaecology, Maternity Building, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK.