Approximately 75 million intermittent catheterisation (IC) catheters are used annually in the UK [1]. Currently, IC is done predominantly with single-use, sterile catheters, largely due to the belief that they cause fewer urinary tract infections (UTI) than reusable catheters [2]. However, there is limited evidence to support this practice [3]. Therefore, a non-inferiority randomized control trial (RCT), sought to determine whether combining reusable and single use catheters (mixed use) was no worse for UTI incidence than single-use catheters only. We conducted an economic evaluation alongside this RCT to evaluate whether mixed-use is cost­effective compared to single-use only for the UK NHS.

Cost-utility and cost-consequence analyses were conducted alongside the trial. The analysis took the UK payer perspective (NHS), using individual patient-level data of the 578 randomized (1:1) trial participants over 12 months. Costs included catheterisation costs, antibiotic costs, and visit costs. Outcomes were measured as Quality-Adjusted Life Years (QALYs), estimated from EQ-5D-5L data using linear interpolation and area under the curve analysis with baseline adjustment. 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% Cl -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 cost of the reusable catheters was around £0.10 compared to the average UK NHS cost of £1.69 for a single-use catheter. [4]

The primary limitation was differential withdrawal rates between groups, accounted for in sensitivity analyses.

Costs associated with the use of single-use intermittent catheters are rising in high-income countries, and many do not offer or promote reusable catheters which could save costs and reduce environmental waste. This study found that Mixed-use (reusable and single-use catheters) was cost-effective compared to Single-use, given a £20,000 willingness to pay threshold, and did not result in significant adverse impact on health-related quality of life. These findings support the provision of reusable catheters on the NHS, and potentially other health services worldwide, enabling users to have choice.

Mixed-use is cost-effective for the UK NHS, and provision of reusable catheters should be considered. These findings are also relevant for other health services worldwide with high single-use catheter costs.

Late-Stage Assessment Final Scope: Intermittent Urethral Catheters for Long­ Term Urinary Management in Adults.; 2024. Accessed May 7, 2025. https://www.nice.org.uk/guidance/indevelopmenUgid-hte10049
McClurg D, Coyle J, Long A, et al. 'A two phased study health care professionals' perceptions of single or multi-use of intermittent catheters. lnt J Nurs Stud. 2017;72. doi:10.1016/j.ijnurstu.2017.04.009
Prieto JA, Murphy CL, Stewart F, Fader M. Intermittent catheter techniques, strategies and designs for managing long-term bladder conditions. Cochrane Database of Systematic Reviews. 2021;2023(3). doi:10.1002/14651858.CD006008.pu b5