Peripherally inserted central catheter versus totally implanted venous port for delivering medium- to long-term chemotherapy: A cost-effectiveness analysis based on propensity score matching

Abstract

Background: Peripherally inserted central catheters (PICCs) and totally implanted vascular access ports (PORTs) have been widely used for medium- to long-term chemotherapy. PICCs are associated with lower insertion cost, but higher complication rates than PORTs. However, there is a paucity of cost-effectiveness comparisons between the devices. We aimed to compare the cost-effectiveness of PICCs and PORTs for medium- to long-term chemotherapy from catheter insertion to removal. Methods: A cost-effectiveness analysis was conducted based on propensity score matching (PSM) from the hospital perspective. Data were collected from a retrospective cohort study. The total cost outcome comprised insertion, maintenance, removal and complication costs. The effectiveness outcome was the complication-free rate. The primary and supplemental outcomes were cost-effectiveness ratios (CERs) and incremental cost-effectiveness ratios (ICERs). Results: A total of 1050 patients (after PSM for 417 patients) were included. The average total cost for 3–6 month ($603.55 ± 78.68 vs $1270.21 ± 128.84), 6–9 month ($731.40 ± 42.97 vs $1414.48 ± 155.43), and 9–12 month ($966.83 ± 53.78 vs $1587.76 ± 160.56) dwell times were all significantly lower for PICCs than for PORTs ( p < 0.001). PICCs were associated with significantly lower complication-free rates than PORTs during the 3–6 month (65.22% vs 90.58%, p < 0.001), 6–9 month (53.33% vs 91.80%, p < 0.001), and 9–12 month (44.44% vs 88.46%, p = 0.015) dwell times. Ultimately, PICCs were associated with lower CERs than PORTs for the 3–6 month (928.54 vs 1395.84) and 6–9 month (1380.00 vs 1537.48) but higher CER for the 9–12 month (2197.34 vs 1804.27) dwell times. ICERs were 2564.08 and 1751.49 with dwell times of 3–6 months and 6–9 months, respectively. Conclusion: This study provided economic evidence that informs vascular access device choice for medium- to long-term chemotherapy. For 3–9 month dwell times, PICCs were more cost-effective than PORTs. Furthermore, ICERs were applied and the choice was determined by willingness-to-pay. For 9–12 month dwell times, PORTs might be more cost-effective than PICCs, and studies with larger sample size would be needed to verify this finding in the future.

Peripherally Inserted Central Catheter-Related Skin Injury in Patients with a Chest Tumor: Characteristics and Risk Factors

“…4,6 However, in the present study, the skin injury rate was 40.8%, with dermatitis accounting for 63.1% of cases (65/103) and mechanical skin damage accounting for the remaining 36.9% (38/103). This rate, which is higher than previous studies, 5,9 may be due to several reasons. The average age of patients in this study was 63 years, and patients older than 50 years are at high risk for PICC-related skin injury.…”

Cost-utility analysis of centrally inserted totally implanted access port (PORT) vs. peripherally inserted central catheter (PICC) in the oncology chemotherapy

“…Comparative cost analyses of these two catheterization techniques have been performed (12)(13)(14), but the health outcomes of patients who receive these two types of catheters have not. There are currently two studies in China that have performed a comparative cost-utility analysis for these catheters (15,16). However, they reported opposite findings, and the cost of PORT insertion has decreased as the centralized purchase catalog continues to be adjusted.…”

Ultrasound‐guided totally implantable venous access ports placement via right brachiocephalic vein in pediatric population: A clinical debut

“…2,3 Currently, totally implantable venous access ports (TIVAPs) are the preferred choice because of their higher cost-effectiveness, fewer complications, and aesthetic advantages compared with peripherally inserted central catheters (PICCs). 4,5 Although there is no consensus regarding venous access approach, ultrasound-guided internal jugular vein (IJV) puncture and subclavian vein (SCV) access based on anatomical landmark for TIVAP implantation are the most common methods in pediatric population. 6,7 However, these two methods have certain drawbacks.…”

“…Central venous access devices are necessary for children with malignancy requiring long‐term intravenous therapy and routine laboratory tests 2,3 . Currently, totally implantable venous access ports (TIVAPs) are the preferred choice because of their higher cost‐effectiveness, fewer complications, and aesthetic advantages compared with peripherally inserted central catheters (PICCs) 4,5 …”