[Elements for a cost/utility analysis of long term intravenous devices]

Area of Science:

• Medical Economics
• Health Technology Assessment
• Vascular Access Devices

Background:

• Long-term intravenous infusions require reliable vascular access.
• Implantable ports (IP), tunneled central catheters (TCC), and repeated peripheral catheterization (RPC) are common strategies.
• Comparing the cost-effectiveness and quality of life associated with these methods is crucial for clinical decision-making.

Purpose of the Study:

• To compare the cost-utility of three long-term intravenous infusion strategies: implantable port (IP), tunneled central catheter (TCC), and repeated peripheral catheterization (RPC).
• To evaluate the impact of each strategy on quality of life and identify the most cost-effective option.

Main Methods:

• A decision analysis model was developed using a decision tree to map sequences of events and consequences for each strategy.
• Event likelihoods were determined through a literature review.
• Costs (material, implantation, removal, complication management) and utilities (efficacy and quality of life) were assigned to each event.

Main Results:

• Repeated peripheral catheterization (RPC) was the most cost-saving strategy but resulted in lower quality of life (0.82).
• Implantable ports (IP) and TCCs incurred higher costs, primarily due to insertion procedures and complication management (deep vein thrombosis, infection).
• IP offered superior quality of life (0.98) compared to TCC (0.93) and a better cost-utility ratio (11,738 FF vs. 17,393 FF).

Conclusions:

• Implantable ports (IP) are superior to tunneled central catheters (TCC) for long-term intravenous infusions based on cost-utility and quality of life.
• Reducing the risk of infection with TCCs by one-third could potentially alter this comparison.
• The decision analysis model provides a valuable framework for evaluating vascular access strategies.