Peripherally Inserted Central Catheter Versus Centrally Inserted Central Catheter for In-Hospital Infusion Therapy: A Cost-Effectiveness Analysis

IF 1.4 Q3 HEALTH CARE SCIENCES & SERVICES Value in health regional issues Pub Date : 2024-02-23 DOI:10.1016/j.vhri.2023.12.006

Simone de Souza Fantin RN, MSc, ScD , Marina Scherer dos Santos RN , Eduarda Bordini Ferro RN , Vania Naomi Hirakata MSc , André Ferreira de Azeredo da Silva MD, PhD , Eneida Rejane Rabelo-Silva RN, MSc, ScD

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Abstract

Objectives

To evaluate the comparative effectiveness and cost-effectiveness of peripherally inserted central catheters (PICCs) compared with centrally inserted central catheters (CICCs).

Methods

Prospective cohort study was followed by an economic analysis over a 30-day time horizon. Propensity score matching was used to select hospitalized adults with similar indications for PICC or CICC. The composite outcome was device removal or replacement because of complications before the end of treatment. The economic evaluation was based on a decision tree model for cost-effectiveness analysis, with calculation of the incremental cost-effectiveness ratio (ICER) per catheter removal avoided. All costs are presented in Brazilian reais (BRL) (1 BRL = 0.1870 US dollar).

Results

A total of 217 patients were followed in each group; 172 (79.3%) of those receiving a PICC and 135 (62.2%) of those receiving a CICC had no device-related complication, respectively. When comparing the events leading to device removal, the risk of composite endpoint was significantly higher in the CICC group (hazard ratio 0.20; 95% CI 0.11-0.35). The cost of PICC placement was BRL 1290.98 versus BRL 467.16 for a CICC. In the base case, the ICER for placing a PICC instead of a CICC was BRL 3349.91 per removal or replacement avoided. On univariate sensitivity analyses, the model proved to be robust within an ICER range of 2500.00 to 4800.00 BRL.

Conclusions

PICC placement was associated with a lower risk of complications than CICC placement. Although the cost of a PICC is higher, its use avoided complications and need for catheter replacement before the end of treatment.

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用于院内输液治疗的外周置入中心导管与中心置入中心导管：成本效益分析

目的评估外周置入中心导管（PICC）与中心置入中心导管（CICC）的比较效果和成本效益。方法进行前瞻性队列研究，然后在 30 天的时间跨度内进行经济分析。采用倾向评分匹配法选择具有类似 PICC 或 CICC 适应症的住院成人。综合结果是在治疗结束前因并发症而移除或更换装置。经济评估采用决策树模型进行成本效益分析，计算每次避免拔除导管的增量成本效益比 (ICER)。所有成本均以巴西雷亚尔（BRL）表示（1 雷亚尔 = 0.1870 美元）。结果每组共有 217 名患者接受了随访；在接受 PICC 和 CICC 的患者中，分别有 172 人（79.3%）和 135 人（62.2%）未发生与设备相关的并发症。在比较导致装置移除的事件时，CICC 组的复合终点风险明显更高（危险比为 0.20；95% CI 为 0.11-0.35）。PICC 置入成本为 1290.98 BRL，而 CICC 为 467.16 BRL。在基础病例中，放置 PICC 而不是 CICC 每避免一次移除或更换的 ICER 为 3349.91 BRL。在单变量敏感性分析中，该模型在 2500.00 至 4800.00 BRL 的 ICER 范围内证明是稳健的。虽然 PICC 的费用较高，但使用 PICC 可以避免并发症和在治疗结束前更换导管的需要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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