A 5-Day Update on the Aurie Reusable Catheter: New Health Economics Paper Shows 96.6% Probability of Cost-Effectiveness, 902 Fewer Single-Use Catheters Per Patient Annually
Published: May 26, 2026
By: Zeeshan Khan
Reading time: 18 minutes
Category: Medical Devices / Healthcare Economics / Public Health
Note: May 26, 2026 – This is an update to the May 22, 2026 article: Landmark Study Finds Reusable Catheters Safe – Does Not Increase UTI Risk as FDA Authorizes First US System
SOUTHAMPTON, England / WASHINGTON, D.C. – May 26, 2026 – Four days after The 5 Ws reported on the landmark MultICath clinical trial demonstrating reusable catheter safety, a peer-reviewed economic evaluation has been published that directly addresses the cost-effectiveness questions raised in that coverage.
On May 25, 2026, the journal Cost Effectiveness and Resource Allocation published the economic evaluation component of the MultICath trial. The analysis, conducted by researchers from the University of Southampton and the London School of Economics, found that mixed-use (reusable/single-use) catheter management is highly cost-effective compared to single-use catheters, with a probability of being cost-effective never below 96.6% at standard UK National Health Service (NHS) willingness-to-pay thresholds.
This economic analysis provides the first peer-reviewed, patient-level cost data for reusable catheters. It directly addresses the economic questions raised in the May 22 article, where Professor Cathy Murphy’s estimates of potential savings (less than 10p per use, millions for the NHS) were based on projections rather than trial-collected data. Now, concrete per-patient savings have been quantified: average annual cost savings of £1,348.82 per patient (approximately $1,690 USD) in the mixed-use group compared to single-use catheters.
The economic evaluation comes as the FDA’s De Novo authorization of the Aurie Reusable No-Touch Intermittent Catheter System™ (granted May 11, 2026) created an entirely new regulatory classification for reusable catheters. The Aurie system pairs a 100-use no-touch catheter with a portable washer-disinfector about the size of a small water bottle. The Veterans Health Administration has signaled interest in deploying the system through its spinal cord injury centers later this year.
The Essentials: Who, What, When, Where, Why, How (Last 96 Hours)
Who: University of Southampton researchers (lead author Professor Mandy Fader, co-author Margaret Macaulay); London School of Economics health economist Dr. James Buchanan; the National Institute for Health and Care Research (NIHR), which funded the study; 578 study participants; the NHS (UK health system); Aurie (US medical device company); the U.S. Food and Drug Administration; and approximately 500,000 Americans who use intermittent catheters regularly.
What: A peer-reviewed economic evaluation conducted alongside the MultICath randomized controlled trial, comparing the costs and cost-effectiveness of mixed-use (reusable/single-use) catheter management versus single-use catheter management for intermittent catheter users. The study found that mixed-use management is highly cost-effective, with a 96.6% probability of being cost-effective at standard NHS thresholds, and generates average annual savings of £1,348.82 per patient.
When: The economic evaluation was published on May 25, 2026, in the journal Cost Effectiveness and Resource Allocation (DOI: 10.1186/s12962-026-00789-2). The research was conducted over a 12-month period with 578 participants, with cost data collected alongside clinical outcomes.
Where: The study was conducted across multiple sites within the UK’s National Health Service (NHS). The findings have direct implications for the U.S. market, where the FDA recently authorized the first reusable catheter system.
Why (Immediate Cause): Prior to this economic evaluation, there was a lack of high-quality, patient-level cost data for reusable catheters. The May 22 article quoted Professor Cathy Murphy’s estimates (less than 10p per use, potential millions in savings), but those were projections rather than trial-verified figures. The new economic analysis provides the actual, peer-reviewed cost data.
How (Mechanism): The economic evaluation used a cost-utility analysis framework, measuring costs in British pounds and health outcomes in quality-adjusted life-years (QALYs). Researchers collected resource use data (catheters, other supplies, NHS visits, hospitalizations, antibiotics) for each of the 578 participants over the 12-month trial period. Unit costs were applied using standard NHS reference costs. The analysis used multiple imputation for missing data and probabilistic sensitivity analysis with 5,000 bootstrap replications to estimate uncertainty.
Specific Changes in the Last 96 Hours (May 22–26, 2026)
1. Economic Evaluation Published in Peer-Reviewed Journal (May 25, 2026)
On May 25, 2026, Cost Effectiveness and Resource Allocation published the economic evaluation of the MultICath trial – the first peer-reviewed, patient-level cost-effectiveness analysis of reusable catheters.
Key Economic Findings from the Southampton/LSE Study:
| Finding | Detail |
|---|---|
| Study size | 578 participants followed for 12 months |
| Analysis perspective | NHS (UK health system) |
| Time horizon | 12 months (trial period) |
| Cost-effectiveness probability (at £20,000/QALY threshold) | 96.6% |
| Cost-effectiveness probability (at £30,000/QALY threshold) | 97.4% |
| Average annual cost savings (mixed-use vs. single-use) | £1,348.82 per patient |
| Average reduction in single-use catheters (mixed-use group) | 902 fewer per patient annually |
| Mean total cost (mixed-use group) | £2,018.85 (95% CI: £1,734.29 to £2,303.41) |
| Mean total cost (single-use group) | £3,367.67 (95% CI: £2,737.71 to £3,997.62) |
| QALY difference (mixed-use vs. single-use) | +0.006 (95% CI: -0.006 to +0.018) |
| Cost per QALY (incremental) | Mixed-use dominant (less costly, more effective) |
Lead author Professor Mandy Fader (University of Southampton) stated: *“Our clinical trial showed reusable catheters are safe. Now we have shown they are also highly cost-effective. The probability that mixed-use management is cost-effective at standard NHS thresholds is never below 96.6%. This provides healthcare systems with the evidence they need to make informed coverage decisions.”*
Dr. James Buchanan (London School of Economics), health economist on the study, added: *“The cost savings we observed are substantial – over £1,300 per patient per year. The mixed-use group used, on average, 902 fewer single-use catheters per patient annually. At the NHS level, these savings would be considerable.”*
Study Details: The full title of the economic evaluation is “Cost-effectiveness of mixed (reusable/single-use) catheter management versus single-use catheter management for intermittent catheter users: an economic evaluation conducted alongside the MultICath randomised controlled trial.”
2. Per-Patient Cost Savings Quantified: £1,348.82 Annually
The economic evaluation provides the first concrete, patient-level cost savings data for reusable catheters, directly addressing the estimate-based statements in the May 22 article.
Average Annual Cost Breakdown (per patient):
| Cost Category | Mixed-Use Group (Reusable) | Single-Use Group | Difference |
|---|---|---|---|
| Catheter costs | £348.21 | £1,951.44 | -£1,603.23 |
| Other NHS resource use | £1,670.64 | £1,416.23 | +£254.41 |
| Total | £2,018.85 | £3,367.67 | -£1,348.82 |
Context on the Cost Difference: The mixed-use group had lower catheter costs (as reusable catheters and cleaning supplies cost less than single-use catheters) but slightly higher other NHS costs (primarily nurse visits, which were more frequent in the mixed-use group as part of the trial protocol). Despite the higher non-catheter costs, the total annual cost was substantially lower in the mixed-use group.
Professor Cathy Murphy (University of Southampton), co-author of the original clinical trial, commented: *“Our earlier estimate that reusable catheters cost less than 10p per use was a projection. Now we have actual trial data showing average annual savings of over £1,300 per patient. The economic case for reusable catheters is now supported by peer-reviewed evidence.”*
3. Environmental Impact Quantified: 902 Fewer Single-Use Catheters Per Patient Annually
The economic evaluation also provides a concrete measure of the environmental benefit: patients in the mixed-use group used, on average, 902 fewer single-use catheters per year compared to patients in the single-use group.
Key environmental finding: *902 fewer single-use catheters per patient annually.*
Context on Total NHS Environmental Impact: The NHS currently prescribes approximately 100 million single-use catheters annually. If 25% of NHS patients switched to mixed-use management (the scenario Professor Murphy referenced in the May 22 article), the annual reduction in single-use catheters would be approximately 22.6 million (assuming comparable reduction per patient).
This quantifies the May 22 article’s statement that “thousands of tonnes of plastic waste” could be eliminated annually. At 902 fewer catheters per patient, and with approximately 100,000-150,000 NHS patients using intermittent catheters regularly, the total reduction could be 90-135 million single-use catheters annually if all patients switched.
4. Cost-Effectiveness Probability: 96.6% at Standard NHS Threshold
The economic evaluation used probabilistic sensitivity analysis with 5,000 bootstrap replications to estimate uncertainty around the cost-effectiveness results. This addresses the question of whether the findings are robust to statistical variation.
Cost-Effectiveness Acceptability Curves (CEACs):
| Willingness-to-Pay Threshold (per QALY) | Probability Mixed-Use is Cost-Effective |
|---|---|
| £0 (cost-saving only) | 94.2% |
| £10,000 | 95.8% |
| £20,000 (standard NHS threshold) | 96.6% |
| £30,000 (standard NHS threshold for some technologies) | 97.4% |
| £50,000 | 98.1% |
Interpretation: At the standard NHS threshold of £20,000 per QALY gained, the probability that mixed-use management is cost-effective is 96.6%. This is well above the typical 80-90% threshold used by NICE (the UK’s health technology assessment body) to recommend adoption.
Dr. James Buchanan explained: *“The probability of cost-effectiveness never drops below 96.6% across all thresholds we tested. This is a remarkably robust finding. Even under conservative assumptions, mixed-use management is highly likely to be cost-effective for the NHS.”*
5. Quality-Adjusted Life-Years (QALYs): Mixed-Use Group Had Slightly Better Outcomes
The economic evaluation measured health outcomes in quality-adjusted life-years (QALYs), a standard metric that combines length of life and quality of life.
QALY Findings:
| Measure | Mixed-Use Group | Single-Use Group | Difference |
|---|---|---|---|
| Mean QALYs (12 months) | 0.817 (95% CI: 0.805-0.829) | 0.811 (95% CI: 0.795-0.827) | +0.006 |
Interpretation: The mixed-use group had slightly higher QALYs (+0.006), though the confidence interval crosses zero (-0.006 to +0.018), meaning the difference is not statistically significant. However, because mixed-use management is less costly, it is considered “dominant” (less costly and at least as effective) compared to single-use management.
Professor Mandy Fader noted: “The QALY difference is not statistically significant, but the direction of effect favors mixed-use management. Combined with the substantial cost savings, the economic case is clear.”
How This Addresses the May 22 Article’s Economic Questions
The May 22 article noted that the clinical trial provided estimates of cost savings (less than 10p per use, potential millions for the NHS) but that these were projections rather than trial-verified figures. The new economic evaluation directly addresses these questions.
| Economic Question from May 22 Article | Addressed by Economic Evaluation (May 25, 2026) |
|---|---|
| “Professor Murphy’s estimate of less than 10p per use” | Confirmed and refined: average annual savings of £1,348.82 per patient |
| “Potential millions in savings for the NHS if 25% of patients switch” | Supported: per-patient savings quantified; 902 fewer single-use catheters per patient |
| “Are reusable catheters cost-effective compared to single-use?” | Yes: 96.6% probability at standard NHS thresholds; mixed-use is dominant |
| “What is the actual per-patient cost difference?” | £1,348.82 lower annual cost in mixed-use group |
| “What are the environmental benefits in concrete terms?” | 902 fewer single-use catheters per patient annually |
However, the following questions from the May 22 article remain unanswered:
| Unanswered Question | Reason |
|---|---|
| Aurie system pricing | Economic evaluation used NHS prices for reusable catheters (not Aurie) |
| US-specific cost savings | Study conducted in UK NHS; US catheter prices, reimbursement rates differ |
| Washer-disinfector cost-effectiveness | Study used manual cleaning (soap/water + chlorine), not automated washer-disinfector |
| VA rollout timing | No US-specific information in UK study |
| 100-use durability claim | Study did not test durability to 100 uses |
| Medicare/private insurer coverage decisions | Study conducted in UK NHS, not US |
Comparison: Before and After the May 25 Economic Evaluation
| Issue | As of May 22 Article | As of May 26, 2026 (Current) |
|---|---|---|
| Evidence for safety | Large-scale RCT (578 patients, 12 months) – unchanged | Unchanged |
| UTI risk comparison | Lower in reusable group (29% vs 34%) – unchanged | Unchanged |
| Antibiotic usage | 35% fewer antibiotics in reusable group – unchanged | Unchanged |
| Economic data | Estimates only (<10p per use, potential millions) | Peer-reviewed: £1,348.82 annual savings per patient; 96.6% cost-effectiveness probability |
| Environmental impact | “Thousands of tonnes of plastic waste” (estimate) | 902 fewer single-use catheters per patient annually |
| Cost-effectiveness probability | Unknown | 96.6% at £20,000/QALY threshold |
| QALY comparison | Unknown | Mixed-use dominant (less costly, more effective) |
| Cleaning protocol validated | Soap/water + chlorine (clinical trial) – unchanged | Unchanged |
| Aurie system pricing | NOT ANNOUNCED – unchanged | NOT ANNOUNCED – unchanged |
| VA rollout timing | Expected “later this year” – unchanged | Expected “later this year” – unchanged |
Arguments For and Against Reusable Catheters (Updated for May 26)
In Favor of Reusable Catheters (Strengthened by New Economic Evidence)
1. Cost-Effectiveness Now Supported by Peer-Reviewed Economic Analysis
The most significant change is the availability of high-quality economic evidence. Prior to May 25, cost-effectiveness was supported by estimates and projections. Now, a peer-reviewed economic evaluation with 578 patients over 12 months provides concrete per-patient savings (£1,348.82 annually) and a 96.6% probability of cost-effectiveness at standard NHS thresholds.
2. Environmental Benefit Quantified
The study provides a concrete measure: 902 fewer single-use catheters per patient annually. This moves beyond general statements about plastic waste to a specific, quantifiable reduction.
3. Cost Savings Are Substantial
Annual savings of £1,348.82 per patient is not a marginal difference. For a healthcare system like the NHS, which prescribes approximately 100 million single-use catheters annually, the cumulative savings from widespread adoption would be substantial.
4. The Economic Case is Robust to Uncertainty
The probabilistic sensitivity analysis (5,000 bootstrap replications) shows that the probability of cost-effectiveness never drops below 96.6%, even under conservative assumptions. This suggests the findings are not driven by statistical noise or specific modeling choices.
5. Mixed-Use Management is Dominant
Mixed-use management is less costly and at least as effective (slightly more effective in QALYs, though not statistically significant). This is the strongest possible economic finding: a new technology that saves money without harming health outcomes.
Against Reusable Catheters (Cautious Concerns Remain)
1. The Economic Evaluation Did Not Test the Aurie System
The economic evaluation used NHS prices for reusable catheters (manual cleaning with soap/water + chlorine). The Aurie system uses an automated washer-disinfector with pre-packaged supply pods. The cost structure of the Aurie system (upfront device cost, consumable pods) is different from the manual cleaning protocol in the trial. The economic evaluation validates the cost-effectiveness of reusable catheters in general, but does not provide specific cost-effectiveness data on the Aurie device.
2. US-Specific Economic Data Still Lacking
The study provides UK-specific economic data (NHS costs, £1,348.82 annual savings). US-specific costs – including the Aurie system’s pricing, Medicare reimbursement rates, and private insurer coverage decisions – remain unknown. The cost savings in the US market could be different due to different catheter prices, labor costs, and healthcare system structures.
3. Aurie System Pricing Still Unannounced
The most immediate practical concern from the May 22 article remains unchanged: Aurie has not announced pricing. Patients and healthcare systems cannot evaluate whether the Aurie system is cost-effective for their specific situation without knowing the upfront cost of the starter system, the per-use cost of consumable pods, and whether and how insurers will cover the system.
4. The Study Did Not Test Durability to 100 Uses
The economic evaluation did not test durability to 100 uses. Aurie’s claim that the reusable catheter lasts for 100 uses remains unverified in real-world use. A catheter that fails after 50 uses would have a different cost-effectiveness profile.
5. Generalizability to US Population Unknown
The study was conducted in the UK NHS with UK patients. While the findings are likely generalizable, differences in healthcare systems, patient populations, and cleaning protocols mean that US-specific validation would be valuable.
What Has Not Changed: Single-Use Catheters Remain Available
The most important aspect of the May 22 article that remains unchanged is that single-use catheters remain fully available. The FDA has not banned disposable catheters, nor has it mandated the use of reusable alternatives.
Current Options for Patients (unchanged):
- Continue using single-use disposable catheters (any brand, any supplier)
- Choose the Aurie reusable system (when commercially available)
- Use a hybrid approach (reusable for daily use, single-use for travel or backup)
The economic evaluation simply adds high-quality evidence supporting the cost-effectiveness of reusable catheters. It does not change the availability of single-use options.
Remaining Concerns (Updated for May 26)
1. Aurie System Pricing Still Unannounced
The most immediate practical concern remains unchanged: Aurie has not announced pricing. Patients and healthcare systems cannot evaluate whether the Aurie system is cost-effective for their specific situation without knowing the upfront cost of the starter system, the per-use cost of consumable pods, and whether and how insurers will cover the system.
2. The Economic Evaluation Did Not Test the Aurie System
While the economic evaluation provides strong evidence that reusable catheters are cost-effective, it did not test the specific Aurie system or its automated washer-disinfector. The Aurie system uses a different cleaning method (automated washer-disinfector with pre-packaged pods) than the study’s manual protocol (soap/water + chlorine).
3. VA Rollout Timing Still Vague
The Veterans Health Administration has signaled interest in deploying the Aurie system through its network of spinal cord injury centers, but specific timing remains unclear. As of May 26, launch is still expected “later this year” with no specific date announced.
4. US-Specific Economic Data Still Lacking
The study provides UK-specific economic data (£1,348.82 annual savings). US-specific costs – including the Aurie system’s pricing, Medicare reimbursement rates, and private insurer coverage decisions – remain unknown.
5. No Competitor Pipeline Yet Public
While the FDA’s creation of a new device classification theoretically opens the market to competitors, no other manufacturer has announced a reusable catheter in development for the U.S. market. Aurie will likely have market exclusivity for at least 12-24 months.
Why This Matters (Updated for May 26)
The economic evaluation is not niche academic research. It matters to patients, taxpayers, and anyone concerned with healthcare sustainability for several reasons:
For patients who use catheters: The study provides evidence that reusable catheters are not only safe but also cost-effective. A patient who was concerned about the economic impact on the healthcare system can now point to peer-reviewed evidence showing that switching to reusable catheters saves money without compromising health outcomes.
For family members of catheter users: Caregivers who were concerned about the financial impact on their family or the healthcare system now have evidence that reusable catheters reduce costs. This may make reusable catheters a more attractive option for home care.
For taxpayers: The study provides concrete per-patient savings: £1,348.82 annually. If similar savings apply to Medicare, Medicaid, and the VA, the cumulative savings to US taxpayers could reach hundreds of millions of dollars annually. For context, approximately 500,000 Americans use intermittent catheters regularly. If all switched to reusable catheters and achieved similar savings (converted to USD at current exchange rates), the annual savings would be approximately $845 million.
For anyone concerned about healthcare sustainability: The study provides a concrete environmental measure: 902 fewer single-use catheters per patient annually. For the NHS alone, if all patients switched, the reduction would be 90-135 million single-use catheters annually.
For healthcare systems considering reusable catheters: The study provides the high-quality economic evidence needed to make informed purchasing and coverage decisions. Prior to May 25, cost-effectiveness was supported by estimates and projections. Now, peer-reviewed economic evidence is available.
The bottom line: The economic evaluation represents a significant step forward in the evidence base for reusable catheters. It directly addresses the cost-effectiveness questions raised in the May 22 article and provides concrete per-patient savings (£1,348.82 annually), a quantified environmental benefit (902 fewer single-use catheters), and a 96.6% probability of cost-effectiveness at standard NHS thresholds. However, it does not answer all remaining questions about the specific Aurie system – pricing, VA rollout timing, and real-world durability remain unknown. The next 12-24 months of post-market experience with the Aurie system will determine whether the FDA’s quiet authorization becomes a landmark moment in medical device regulation or a cautionary tale.
Current Status (As of May 26, 2026)
| Element | Status |
|---|---|
| Southampton MultICath clinical trial | PUBLISHED May 21, 2026 in International Journal of Nursing Studies – unchanged |
| Economic evaluation | PUBLISHED May 25, 2026 in Cost Effectiveness and Resource Allocation |
| Cost-effectiveness probability | 96.6% at £20,000/QALY threshold |
| Average annual cost savings | £1,348.82 per patient |
| Reduction in single-use catheters | 902 fewer per patient annually |
| Study finding on UTI risk | Reusable catheters non-inferior; 29% UTI rate vs 34% for single-use – unchanged |
| Study finding on antibiotics | 35% fewer antibiotics in reusable group – unchanged |
| FDA De Novo authorization (Aurie) | GRANTED (May 11, 2026) – unchanged |
| Aurie system pricing | NOT ANNOUNCED – unchanged |
| Commercial availability | NOT YET – unchanged |
| VA rollout | EXPECTED “LATER THIS YEAR” – unchanged |
| Medicare coverage decision | PENDING – unchanged |
| Competitor announcements | NONE – unchanged |
| Does the economic evaluation test the Aurie system? | NO – study used manual cleaning, not automated washer-disinfector |
Sources
- Cost Effectiveness and Resource Allocation (May 25, 2026) – “Cost-effectiveness of mixed (reusable/single-use) catheter management versus single-use catheter management for intermittent catheter users: an economic evaluation conducted alongside the MultICath randomised controlled trial.” DOI: 10.1186/s12962-026-00789-2
- University of Southampton (May 26, 2026) – Press release: “Reusable catheters cost-effective, landmark study shows.” Available at: southampton.ac.uk/news
- London School of Economics (May 26, 2026) – Statement from Dr. James Buchanan on economic evaluation findings.
- International Journal of Nursing Studies (May 21, 2026) – “Mixed (reusable/single-use) catheter management versus single-use catheter management for intermittent catheter users (MultICath): A non-inferiority randomised controlled trial.” DOI: 10.1016/j.ijnurstu.2026.105536
- National Institute for Health and Care Research (NIHR) – Funding acknowledgment for the MultICath trial.
- Previous article: Landmark Study Finds Reusable Catheters Safe – Does Not Increase UTI Risk as FDA Authorizes First US System (The 5 Ws, May 22, 2026) – Baseline information on clinical trial findings, FDA authorization, Aurie system, and remaining concerns.
- Previous article: FDA Authorizes First Reusable Catheter After 50 Years of Disposables – But Washer-Disinfector Cost Remains Unclear (The 5 Ws, May 19, 2026) – Baseline information on FDA authorization, Aurie system, VA rollout plans.
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