1 Recommendations

1.1

There is not enough evidence to determine whether price variation is justified between different intermittent urethral catheters for chronic incomplete bladder emptying in adults.

1.2

Service providers should provide access to a range of intermittent urethral catheters, so that catheters that meet people's needs and preferences and are clinically appropriate are available for them.

1.3

A healthcare professional and the person with chronic incomplete bladder emptying should decide together which intermittent urethral catheters to use (see the NICE page on shared decision making). Decisions should take into account:

ease and comfort of use
risk of infection.

1.4

If more than 1 catheter meets the person's needs and preferences and is clinically appropriate, choose the least expensive.

What information is needed

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 the preferences of people using intermittent urethral catheters. 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
patient-reported outcomes, including patient satisfaction
adverse events
how a feature contributes to an outcome.

What this means in practice

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 (as of November 2024).
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.

Considerations for healthcare professionals

Many factors can influence which type of intermittent catheter is most appropriate and how effective it might be.
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.
More than 1 type of catheter may need to be prescribed to suit different settings and situations. Recommendation 1.4 should be considered for each type of catheter that a person needs.
Inform people with chronic incomplete bladder emptying that there is a range of catheters available and offer them:
- a choice of catheters
- training on how to use each type of catheter
- regular review of the chosen catheter's suitability, which may change over time.
These recommendations are not intended to affect existing catheter use if the person's catheter is clinically appropriate and meets their needs. The recommendations should be considered when people are changing catheter or reviewing their catheter use.

Information for people with chronic incomplete bladder emptying

You should be told about the range of catheters available and given a choice of catheters that are suitable for you.
You should be given training on how to do intermittent catheterisation.
If catheters that you are using cause complications, such as pain or discomfort, urinary tract infection or bleeding, you should be supported to see if changing the catheter type helps.

NICE has produced tools and resources to support the implementation of this guidance.

Why the committee made these recommendations

Intermittent catheters are used for catheterisation for bladder emptying, particularly for long-term bladder management. There are many intermittent catheters available, which vary in features and cost. This assessment aims 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 also 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. Evidence from people who use intermittent catheters for bladder drainage shows that the most important factors for them are ease and comfort of insertion and risk of infection. It also shows that their needs, preferences and experiences of using intermittent catheters vary.

There is not enough evidence to determine whether price variation between catheters with different features is justified, and more information is needed.