Clean intermittent catheterization (CIC) is the primary treatment for patients with urinary retention and is predominantly performed using single-use catheters. Expenditure on single-use catheters in the Netherlands has risen substantially over recent decades, from €16.4 million in 1997 to €74.6 million in 2018 (1). Reusable catheters could offer a cost-reducing alternative to address this growing financial burden. Previous research has demonstrated that reusable catheters are equally safe and well-accepted by patients compared to single-use catheters (2). The present study therefore investigates whether reusable catheters are also cost-effective compared to single-use catheters from a societal and healthcare perspective.

For the economic evaluation, both cost- and effectiveness data were collected over the 12-month follow-up period of the COMPaRE study. Cost data were obtained through self-reported catheter use, iMTA Medical Consumption Questionnaire (iMCQ), and the iMTA Productivity Cost Questionnaire (iPCQ). Utilities were measured using the EQ-5D-5L utility instrument. Incremental costs and effects were estimated using seemingly unrelated regression, with missing data handled using multiple imputation. Uncertainty was assessed using non-parametric bootstrapping (5,000 replications).

Reusable catheters had lower costs than single-use catheters (Δcost −€7,787; 95% CI −€12,770 to −€3,027) and similar effects (ΔQALY 0.005; 95% CI −0.016 to 0.026), indicating dominance of reusable catheters over single-use catheters. Incremental net monetary benefit (iNMB) was positive at €20,000/QALY (iNMB €7,883). Bootstrap analyses were consistent with the deterministic results, showing a 99.3% probability that reusable catheters are cost-effective at €20,000 per QALY.

Reusable catheters were associated with substantial cost savings compared to single-use catheters. The substantial cost reduction, combined with a small albeit statistically non-significant improvement in QALYs, renders reusable catheters highly cost-effective compared to single-use catheters.

These findings provide a strong evidence base for implementing reusable catheters as a cost-effective alternative to single-use catheters. In combination with the previously reported safety and acceptance by patients, these findings support their wider adoption in urology practice.

1.	Berendsen SA, van Doorn T, Blok BFM. Trends in the use and costs of intermittent urinary catheters in the Netherlands from 1997 to 2018: A population-based observational study. Neurourol Urodyn. 2021;40(3):876-82.
2.	Van Veen FEE, Christiaans CHH, Berendsen SA, et al. Safety of Single-use vs Reusable Catheters for Intermittent Catheterization in Patients with Urinary Retention: Primary Results of the COMPaRE Randomized Clinical Trial. JAMA Open Network. Submitted.