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Central Venous Access Devices for the Delivery of Systemic Anticancer Therapy: An Economic Evaluation

Robert Heggie1, Nishant Jaiswal1, Elaine McCartney2

  • 1Health Economics and Health Technology Assessment (HEHTA), School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK.

Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research
|October 16, 2023
PubMed

Insights

Implantable chest wall ports (PORT) are safer and more cost-effective for long-term cancer therapy than Hickman-type devices (HICK) or peripherally inserted central catheters (PICC). PORT reduces complications and unplanned removals, offering value within the National Health Service.

Area of Science:

  • Oncology
  • Medical Devices
  • Health Economics

Background:

  • Long-term anticancer therapy often requires venous access devices like Hickman-type devices (HICK), peripherally inserted central catheters (PICC), or implantable chest wall ports (PORT).
  • While PORT shows improved safety and patient satisfaction, its cost-effectiveness compared to HICK and PICC requires further evaluation.
  • Traditional cost-per-quality-adjusted life-year metrics may not fully capture the benefits of medical devices.

Purpose of the Study:

  • To assess the cost-effectiveness of HICK, PICC, and PORT in routine clinical practice for patients undergoing long-term anticancer therapy.
  • To compare trade-offs between complications, infections, chemotherapy interruptions, device removals, health utilities, and costs associated with each device type.
  • To conduct a value of implementation analysis for PORT services within the National Health Service.

Main Methods:

  • A cost-consequence analysis was performed using data from the Cancer and Venous Access clinical trial.
  • Key outcomes evaluated included complication rates, infection rates, chemotherapy interruption, unplanned device removals, health utilities, and total costs.
  • Value of implementation analysis was utilized to assess the cost-effectiveness of PORT services.

Main Results:

  • PORT demonstrated a significantly lower overall complication rate compared to both HICK and PICC.
  • PORT was associated with fewer unplanned device removals than HICK and PICC.
  • Total costs for PORT were lower than HICK and comparable to PICC, with PORT likely to be considered cost-effective within the NHS.

Conclusions:

  • Implantable chest wall ports (PORT) offer superior safety and cost-effectiveness compared to HICK and PICC for long-term venous access in cancer patients.
  • PORT reduces complications and unplanned removals, making it a valuable option for routine clinical practice.
  • Healthcare decision-makers should consider integrating PORT into the available venous access device options within the National Health Service.
Abstract

Keywords:
cost-consequencevalue of implementationvenous access device

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