Background Subcutaneous central venous access ports (CVPs) and peripherally inserted central catheters (PICCs) are two widely used devices for the administration of chemotherapy. Many studies focus on their complications but no cost study could be found in the literature.
Purpose To determine which technique allows cost minimization in the administration of chemotherapy.
Materials and Methods We constructed a Markov chain (Tree-Age Software) from literature data in which probabilities were adjusted to the duration of one cycle (21 days).
Time horizon was 5 cycles. Population was oncohaematology.
Four states were identified for patients: absence of complications; mechanical complications, infectious complications and obstructive thrombotic complications.
Three consequences were isolated: the maintenance, removal or reinstallation of the catheter.
Costs were estimated from care protocols of a French University Hospital, from treatment recommendations and the French ‘Common Classification of Medical Acts’.
Results Adjusted complication rate (%): (Table)
Cost of these strategies:
PICC (with fixture) = €542
PICC (without fixture) = €486
CVP = €550
The financial gain on the purchase of PICCs doesn’t recoup the costs associated with maintenance and management of their complications.
Limits: the study is based on a literature review with a low number of subjects (PICCs) and foreign data (CVPs).The foreign data cannot necessarily be applied to French practise (PICC thrombosis rate in France < international rate).
Moreover unlike the CVP group, the majority of PICC complications are mechanical and therefore depend on the hospital maintenance practises.
Conclusions Costs incurred by the two strategies are equivalent; however we economise on PICCs when the care protocol doesn’t change the fixture every time.
No conflict of interest.
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