A new economic evaluation of the landmark RSVP trial reveals that adopting 7-day routine IV replacement (deemed “non-inferior” to every-3-day changes based on acute catheter infection rates) may actually be harmful and costly when real-world consequences are considered.

Even a small increase in catheter-related bloodstream infections (CRBSI) with the longer interval translates into substantial downstream morbidity, mortality, and expense; in the Australian context, sticking with clinically indicated replacement only (instead of routine 7-day changes) dominates as both healthier and cheaper.

The authors warn that declaring “statistical equivalence” on narrow, short-term endpoints can mislead global policy if the slightly higher infection risk triggers large health and economic burdens, underscoring the urgent need for early, comprehensive cost-effectiveness analyses that go beyond p-values and non-inferiority margins to capture the full patient and system impact.

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