JAMA：七天与四天更换输液器间隔及导管相关感染的比较

Abstract

Importance: Catheter-related bloodstream infections (CRBSIs) are associated with longer hospital stays and increased mortality risks. The Replacement at Standard vs Prolonged Interval (RSVP) trial found that central venous access devices and peripheral arterial catheter infusion set replacement intervals can be extended from 4 to 7 days without increasing infection risk by more than 2%. However, the trial did not consider the full cost and health trade-offs of extending replacement intervals.

重要性：导管相关血流感染（Catheter-related bloodstream infections, CRBSIs）与住院时间延长及死亡风险增加有关。标准更换间隔与延长更换间隔的比较试验（Replacement at Standard vs Prolonged Interval, RSVP）发现，中心静脉通路装置和周围动脉导管输液套件的更换间隔可从每4天延长至每7天，而不会使感染风险增加超过2%。然而，该试验并未考虑延长更换间隔所带来的全部成本与健康权衡。

Objective: To estimate the changes in total cost and health benefits associated with a decision to adopt 7-day vs standard 4-day replacement intervals via decision-analytic modeling.

目的：通过决策分析建模，估算采用每7天更换策略相较于标准每4天更换策略在总成本与健康效益方面的变化。

Design, setting, and participants: In this economic evaluation, a decision tree model was developed on August 26, 2025, from a health care perspective incorporating data from patients in the RSVP randomized clinical trial conducted from 2011 to 2016 across 10 Australian hospitals. Data were analyzed from December 12, 2016, to April 23, 2019.

设计、场所与参与者：本经济评估研究于2025年8月26日构建了一个从医疗系统角度出发的决策树模型，纳入了2011年至2016年间在澳大利亚10家医院开展的RSVP随机临床试验中的患者数据。数据分析时间为2016年12月12日至2019年4月23日。

Main outcomes and measures: A probabilistic sensitivity analysis generated a joint distribution of the expected change to cost and effectiveness outcomes. Parameter uncertainty was assessed, a cost effectiveness acceptability curve was plotted, and a value of information analysis was done.

主要结果与测量指标：采用概率敏感性分析生成了成本与效果预期变化的联合分布。评估了参数不确定性，绘制了成本效果可接受性曲线，并进行了信息价值分析。

Results: Of 2941 patients from the RSVP trial (median age, 59.0 years; range, 47-68 years), 62.9% were male. Of patients, 62.6% were admitted to intensive care, and common specialties were medical, hematology, and emergency surgical. A CRBSI risk of 1.78% in the 7-day group and 1.46% in the standard 4-day group was reported. The 7-day strategy was associated with annual savings of approximately 52 million Australian dollars (A$) (95% uncertainty interval [UI], -A$42 841 427 to A$181 823 300) from fewer set changes, offset by A$3.1 million (95% UI, -A$6 974 903 to A$14 099 754) in additional costs for treating CRBSI. The expected health outcomes were 395 (95% UI, -945 to 1739) additional infections, 103 (95% UI, -246 to 452) excess deaths, and 1724 (95% UI, -4199 to 7925) life-years lost at the population level. At a willingness-to-pay threshold of A$28 033, the probability that the 7-day strategy is cost-effective was 50.3%, and the probability that it is cost-saving was 82.67%.

结果：在RSVP试验的2941名患者中（中位年龄59.0岁；年龄范围47–68岁），62.9%为男性。62.6%的患者入住重症监护病房，常见专科包括内科、血液科和急诊外科。7天更换组报告CRBSI发生率为1.78%，标准4天更换组为1.46%。7天更换策略因减少更换次数每年可节省约5200万澳元（A$，95%不确定区间[UI]：-4284万至1.818亿澳元），但治疗CRBSI的额外成本为310万澳元（95% UI：-697万至1409万澳元）。在人群层面，预期健康结果为新增395例感染（95% UI：-945至1739）、额外死亡103例（95% UI：-246至452）以及损失1724个生命年（95% UI：-4199至7925）。在以28,033澳元为支付意愿阈值下，7天更换策略具有成本效果的几率为50.3%，具有成本节约的几率为82.67%。

Conclusions and relevance: In this economic evaluation of the RSVP trial, a small increase in CRBSI risk was associated with large cost-savings and substantial health losses at the population level. While the RSVP trial assumed that a 2% equivalence margin was acceptable, the use of such arbitrary difference margins might not consider information that could change decision-making outcomes. The clinical and economic impacts of small increases to infections appear to be important for decision-making inference.

结论与意义：在这项对RSVP试验的经济评估中，CRBSI风险的轻微增加伴随着在人群层面上的大幅成本节约和显著的健康损失。尽管RSVP试验假定2%的等效界值是可接受的，但使用这种任意设定的差异界限可能忽视了可能改变决策结果的重要信息。对于小幅增加的感染所带来的临床与经济影响，在决策推断中应予以高度重视。