Central venous access device-associated complication costs in paediatric cancer care

Central venous access devices (CVADs) are commonly inserted in paediatric patients requiring cancer treatment and supportive care. However, these devices carry a high risk of complications such as central line-associated bloodstream infections (CLABSI), venous thromboembolism (VTE), and occlusion, and are associated with significant management costs. This study aimed to determine the average cost of each CVAD-associated complication type, per complication event, and investigate which elements are the key cost drivers of these estimates.

This Australian prospective observational cohort study, embedded within a randomised controlled trial, acquired data from hospital purchasing departments, the Medicare Benefits Schedule Book, the National Hospital Cost Data Collection (NHCDC) Public Sector 2022-2023 Report, and local (state-based) enterprise bargaining agreements. Price per resource unit was multiplied by associated resource use and summed across all resources to estimate the mean complication cost per event. An average cost per complication event for each complication type was then determined.

In a sample of 310 paediatric oncology patients, 101 unique patients experienced 275 CVAD-associated complication events. Of these events, estimated per-event direct costs for CVAD-associated complications were as follows: occlusion (A$2712 (95% CI $1198-$4225)), CVAD-associated venous thromboembolism (A$17,510 (95% CI $5840-$29,181)), confirmed CLABSI (A$38,995 (95% CI $22,394-$55,596)), and suspected CLABSI (A$16,030 (95% CI $12,971-$19,090)).

CVAD-associated complications remain a palpable cost in paediatric cancer care, with CLABSI carrying the highest cost burden. Therefore, investing in preventative care is encouraged to minimise the burden of complication costs to the healthcare system, and reduce the physical and emotional burden on patients and their families. With admission costs comprising a high percentage of complication-associated costs, efficient and effective evidence-based care must be delivered to ensure a shorter length of stay, simultaneously improving the patient experience.