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However, urinary infections associated with catheters cause significant patient discomfort and burden hospital resources. A nurse led intervention aiming to reduce inpatient catheterisation rates was recently trialled among adult overnight patients in four New South Wales hospitals. It included: \u2018train-the trainer\u2019 workshops, site champions, compliance audits and promotional materials. This study is the \u2018in-trial\u2019 cost-effectiveness analysis, conducted from the perspective of the New South Wales Ministry of Health.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The primary outcome variable was catheterisation rates. Catheterisation and procedure\/treatment data were collected in three point prevalence patient surveys: pre-intervention (<jats:italic>n<\/jats:italic>\u2009=\u20091630), 4-months (<jats:italic>n<\/jats:italic>\u2009=\u20091677), and 9-months post-intervention (<jats:italic>n<\/jats:italic>\u2009=\u20091551). Intervention costs were based on trial records while labour costs were gathered from wage awards. Incremental cost effectiveness ratios were calculated for 4- and 9-months post-intervention and tested with non-parametric bootstrapping. Sensitivity scenarios recalculated results after adjusting costs and parameters.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The trial found reductions in catheterisations across the four hospitals between preintervention (12.0\u2009% (10.4 \u2212\u200913.5\u2009%), <jats:italic>n<\/jats:italic>\u2009=\u2009195) and the 4- (9.9\u2009% (8.5 \u2212\u200911.3\u2009%), <jats:italic>n<\/jats:italic>\u2009=\u2009166 ) and 9- months (10.2\u2009% (8.7 \u2212\u200911.7\u2009%) <jats:italic>n<\/jats:italic>\u2009=\u2009158) post-intervention points. The trend was statistically non-significant (<jats:italic>p<\/jats:italic>\u2009=\u20090.1). Only one diagnosed CAUTI case was observed across the surveys. However, statistically and clinically significant decreases in catheterisation rates occurred for medical and critical care wards, and among female patients and short-term catheterisations. Incremental cost effectiveness ratios at 4-months and 9-months post-intervention were $188 and $264. Bootstrapping found reductions in catheterisations at positive costs over at least 72\u2009% of iterations. Sensitivity scenarios showed that cost effectiveness was most responsive to changes in catheterisation rates.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Analysis showed that the association between the intervention and changes in catheterisation rates was not statistically significant. However, the intervention resulted in statistically significant reductions for subgroups including among short-term catheterisations and female patients. Cost-effectiveness analysis showed that reductions in catheterisations were most likely achieved at positive cost.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial Registration<\/jats:title>\n                <jats:p>Registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000090314). First hospital enrolment, 15\/11\/2016; last hospital enrolment, 8\/12\/2016.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12913-021-06871-w","type":"journal-article","created":{"date-parts":[[2021,8,31]],"date-time":"2021-08-31T16:32:43Z","timestamp":1630427563000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Administration of indwelling urinary catheters in four Australian Hospitals: cost-effectiveness analysis of a multifaceted nurse-led intervention"],"prefix":"10.1186","volume":"21","author":[{"given":"Rod","family":"Ling","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Giles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Searles","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,8,31]]},"reference":[{"issue":"1","key":"6871_CR1","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.jhin.2016.01.012","volume":"93","author":"BG Mitchell","year":"2016","unstructured":"Mitchell BG, Ferguson JK, Anderson M, Sear J, Barnett A: Length of stay and mortality associated with healthcare-associated urinary tract infections: a multi-state model. 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H-2016-0123) and carried out in accordance with the principles of the Declaration of Helsinki. Given that patients were receiving routine care in alignment with best practice principles in relation to IDC usage, the ethics committees deemed that consent was not required from patients. The trial was also registered retrospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12617000090314 (17 January 2017, (retrospectively)). The first hospital enrolment was at 15\/11\/2016; while the last enrolment was at 8\/12\/2016.[] [] The study adhered to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and Consolidated Standards of Reporting Trials (STROBE) guidelines (Additional Files  and ). The original effectiveness study[] was performed in conformance with the StaRI checklist.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors have completed the unified completing interest form (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"897"}}