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Economic evaluation of quality improvement interventions to prevent catheter-associated urinary tract infections in the hospital setting: a systematic review
  1. Sara G McCleskey1,2,
  2. Lili Shek1,
  3. Jonathan Grein1,
  4. Hiroshi Gotanda1,
  5. Laura Anderson1,3,
  6. Paul G Shekelle4,5,
  7. Emmett Keeler5,
  8. Sally Morton6,
  9. Teryl K Nuckols1,5
  1. 1 Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
  2. 2 Health Policy & Management, UCLA, Los Angeles, California, USA
  3. 3 Center for Observational Research, Amgen, Thousand Oaks, California, USA
  4. 4 Department of Medicine, West Los Angeles Vet Administration, Los Angeles, California, USA
  5. 5 RAND Corporation, Santa Monica, California, USA
  6. 6 Knowledge Enterprise, Arizona State University, Tempe, Arizona, USA
  1. Correspondence to Sara G McCleskey, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; sara.mccleskey{at}


Background Hospitals have implemented diverse quality improvement (QI) interventions to reduce rates of catheter-associated urinary tract infections (CAUTIs). The economic value of these QI interventions is uncertain.

Objective To systematically review economic evaluations of QI interventions designed to prevent CAUTI in acute care hospitals.

Methods A search of Ovid MEDLINE, Econlit, Centre for Reviews & Dissemination, New York Academy of Medicine’s Grey Literature Report, WorldCat, IDWeek conference abstracts and prior systematic reviews was conducted from January 2000 to October 2020.

We included English-language studies of any design that evaluated organisational or structural changes to prevent CAUTI in acute care hospitals, and reported programme and infection-related costs.

Dual reviewers assessed study design, effectiveness, costs and study quality. For each eligible study, we performed a cost-consequences analysis from the hospital perspective, estimating the incidence rate ratio (IRR) and incremental net cost/savings per hospital over 3 years. Unadjusted weighted regression analyses tested predictors of these measures, weighted by catheter days per study.

Results Fifteen unique economic evaluations were eligible, encompassing 74 hospitals. Across 12 studies amenable to standardisation, QI interventions were associated with a 43% decline in infections (mean IRR 0.57, 95% CI 0.44 to 0.70) and wide ranges of net costs (mean US$52 000, 95% CI −$288 000 to $392 000), relative to usual care.

Conclusions QI interventions were associated with large declines in infection rates and net costs to hospitals that varied greatly but that, on average, were not significantly different from zero over 3 years. Future research should examine specific practices associated with cost-savings and clinical effectiveness, and examine whether or not more comprehensive interventions offer hospitals and patients the best value.

  • quality improvement
  • nosocomial infections
  • cost-effectiveness

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information.

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  • Funding Agency for Healthcare Research and Quality (R01 HS22644-01).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.