Indwelling Pleural Catheters for Malignant Pleural Effusion

Abstract

Malignant pleural effusion (MPE) resulting from metastatic spread to the pleura frequently occurs in patients with primary lung, breast, hematological, gastrointestinal, and gynecological cancers. These effusions tend to reaccumulate quickly, and the patient requires increasingly frequent thoracentesis. An indwelling pleural catheter allows for dramatic improvement in quality of life as the patient has the power to ease her/his own suffering by draining the effusion at home when shortness of breath and/or chest pain intensifies. Patients with MPE need home healthcare support to address symptom management related to complications of advanced metastatic cancer and antineoplasm treatment regimens. The financial obstacles for the home healthcare agency are explored by using agency supply costs, per visit costs, and the patient-driven groupings reimbursement mode grouper to estimate reimbursement. Care for a home healthcare patient with MPE costs Medicare approximately $64.50 per day, markedly less than costs for hospitalization and outpatient thoracentesis. Unfortunately, agencies must absorb the cost of vacuum drainage bottles. Whereas a small positive balance of $291 was estimated for the first 30-day posthospital episode, losses were estimated at $1,185 to $1,633 for subsequent 30-day episodes. Absorbing these costs has become extremely difficult as home healthcare agencies are experiencing unprecedented COVID-19 infection control and staffing-related costs.

Disparities in Access and Use of PleurX Catheters for Treatment of Malignant Pleural Effusion: A Literature and Experience Based Review

“…Currently, under the patient-driven groupings model of medicare reimbursement for home-health services, PleurX vacuum bottles are classified as bundled non-routine supplies, and the home-health agency is responsible for their cost. The agency is compensated for their service based on patient characteristics, but not on the actual cost of the product, leading them to take a loss for patients with a PleurX catheter [11]. This cost either gets absorbed by the home-health agency or is passed on to patients, directly or indirectly.…”