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Efficacy and economic evaluation of a volume-based cathflo activase protocol versus a fixed-dose alteplase protocol
Jennifer A Gilarde1, Allison M Chung, Rosa Vidal
1Department of Pharmacy, Children's Hospital Boston, Boston, Massachusetts.
Insights
The Cathflo Activase protocol demonstrated comparable efficacy to the alteplase protocol for pediatric central venous catheter clearance. This new protocol also offers significant cost savings and potential time benefits.
Area of Science:
- Pediatric critical care medicine
- Pharmacology
- Vascular access management
Background:
- Central venous catheter (CVC) occlusion is a common complication in pediatric patients, necessitating timely and effective clearance.
- Traditional fixed-dose alteplase protocols have been used, but their efficacy and economic impact warrant further investigation.
- Evaluating alternative protocols, such as volume-dependent dosing with Cathflo Activase, is crucial for optimizing CVC management.
Purpose of the Study:
- To compare the efficacy and economic benefits of Cathflo Activase with a volume-dependent protocol against a fixed-dose alteplase protocol for CVC clearance in pediatric patients.
- To assess the success rates, resolution of occlusion, and treatment failures for both protocols.
- To determine the cost-effectiveness of each approach in managing CVC occlusions.
Main Methods:
- A prospective study design was employed, comparing a new Cathflo Activase volume-dependent protocol with a historical fixed-dose alteplase protocol.
- Data from 48 pediatric patients (96 courses) with medically diagnosed catheter occlusions were analyzed retrospectively and prospectively.
- Key data points included catheter type, dose, dwell time, outcome, and cost per dose.
Main Results:
- Complete resolution of CVC occlusion was achieved in 69.6% with alteplase versus 82% with Cathflo Activase.
- Treatment failure rates were lower with Cathflo Activase (10%) compared to alteplase (21.7%).
- The average cost per dose was significantly lower for Cathflo Activase ($30.56) than for alteplase ($49.68).
Conclusions:
- The Cathflo Activase protocol is a potentially efficacious alternative for pediatric CVC clearance, demonstrating comparable or improved success rates.
- The volume-dependent Cathflo Activase protocol offers significant cost benefits compared to the fixed-dose alteplase protocol.
- Implementation of the Cathflo Activase protocol may lead to improved resource utilization and cost savings in managing CVC occlusions.
Objectives:
This prospective study evaluated the efficacy and economic benefit of Cathflo Activase and a volume-dependent protocol versus a previously utilized fixed-dose 2 mg/mL alteplase aliquot protocol for central venous catheter clearance in pediatric patients.
Methods:
All pediatric patients with a medically diagnosed catheter occlusion were eligible for inclusion into this study. Retrospective data was analyzed from an approved data collection form, which had been implemented during the utilization of the alteplase protocol. Data collection indicators included catheter type, dose, dwell time, outcome of attempt (successful or unsuccessful), additional measures taken, and comments. A new protocol utilizing Cathflo Activase and manufacturer recommended volume-based dosing was prospectively implemented and data was collected and evaluated and compared to data from the alteplase protocol.
Results:
Alteplase and Cathflo protocol data was evaluated for a total of 96 courses in 48 patients (0.09 - 22.8 years, 2.15 - 105.2 kg). Complete resolution was achieved in 69.6% of patients with the alteplase protocol, partial resolution was attained in 8.7%, and treatment failure occurred in 21.7% of patients. For the Cathflo Activase group, complete resolution was observed in 82% of occlusions, with 8% partial resolution and treatment failure of 10%. The average cost per dose utilized by our patients during this study was $49.68 and $30.56 for the alteplase and Cathflo Activase groups, respectively.
Conclusions:
Our data indicate that the Cathflo Activase protocol may be as efficacious as the previous alteplase protocol. Furthermore, there are added time and cost benefits.
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