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There is not enough evidence to determine whether price variations between different intermittent urethral catheters are justified. So, if more than one catheter is available use the least expensive catheter that:
is clinically appropriate, and
meets the preferences and needs of the person with chronic incomplete bladder emptying.
A healthcare professional and the person with chronic incomplete bladder emptying should decide together which intermittent urethral catheter to use. Decisions should take into account:
ease and comfort of insertion
risk of infection.
Urology services should have access to a range of intermittent urethral catheters available for prescription in the NHS, so that adults with chronic incomplete bladder emptying can have the most appropriate catheter for them.
More information is needed to show if price variation between different intermittent urethral catheters can be justified and attributed to any specific feature.
Evidence should compare catheter features with each other to show if a specific feature affects outcomes and user preferences. Evidence should be generated across different groups of people who use intermittent catheters for bladder drainage, through formal research studies or real-world evidence.
A core outcome set, including validated patient-reported outcomes, should be developed so that outcomes can be reported consistently. Features should be classified consistently so they can be assessed in a standardised way.
Key outcomes and information that should be captured include:
details of the catheter features
incidence of urinary tract infection
incidence of haematuria, in particular macroscopic or visible haematuria
residual urine volume (the volume of urine remaining in the bladder after catheterisation)
comfort during catheterisation (insertion and removal)
ease of use
health-related quality of life
adverse events
how a feature contributes to an outcome.
Considerations for procurement and commissioning
In 2023 to 2024, a total of 95,437,405 intermittent catheters were prescribed in the NHS, and the price per catheter ranged from £0.40 to £3.28.
Many factors can influence which type of intermittent catheter is most appropriate to use and how effective it might be.
Some features might be needed for specific groups or people in specific situations. For example, people with mobility issues might benefit from catheters with an integrated drainage bag. People with reduced manual dexterity might need catheters with specially designed packaging for ease of opening or catheters with handles or grippers for ease of handling.
Features that meet clinical needs and user preferences may be worth paying more for. But not all features are associated with higher prices.
If a company introduces a catheter with new features to the market, evidence of clinical superiority should be provided to show additional value. Evidence should also show how it makes a difference in outcomes and contributes to people's needs and preferences.
Considerations for healthcare professionals
Decide together with the person with chronic incomplete bladder emptying which catheter to use, following the principles of NICE's guidance on shared decision making.
Offer a choice of catheters to the person with chronic incomplete bladder emptying, and offer training on how to use each type of catheter.
It may be appropriate to prescribe more than one type of catheter to be able to meet the person's needs and lifestyle in different settings and situations.
Information for people with chronic incomplete bladder emptying
People with chronic incomplete bladder emptying should be given a choice of catheter and training on how to perform intermittent catheterisation.
If the person is using a catheter that causes complications, such as pain or discomfort, urinary tract infection or bleeding, they should be offered support to see if changing the catheter type will help.
Intermittent catheters are used for catheterisation for medical bladder emptying, particularly for long-term bladder management. There are many intermittent catheters available, which vary in features and cost. Most variation in prices of intermittent urethral catheters can be accounted for by basic and additional features. This assessment aimed to determine whether the differences in clinical, economic and non-clinical outcomes attributed to those features could justify price variation.
There is no robust clinical evidence of the effectiveness of individual features of catheters. The available evidence does not consistently report on the most important outcomes. Where there is limited evidence for a particular feature, there is a lack of information about how the reported outcome can be attributed to that feature. User-centred work shows that the most important factors for people who use intermittent catheters for bladder drainage are ease and comfort of insertion and risk of infection. It also shows that people's needs, preferences and experiences of using intermittent catheters varied.
There is not enough evidence to determine whether price variations between catheters with different features are justified, and more information is needed.
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