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01-11-2014 | Healthcare Policy and Outcomes

Cost Effectiveness of Different Central Venous Approaches for Port Placement and Use in Adult Oncology Patients: Evidence From a Randomized Three-Arm Trial

Authors: Roberto Biffi, MD, Simonetta Pozzi, MD, Guido Bonomo, MD, Paolo Della Vigna, MD, Lorenzo Monfardini, MD, Davide Radice, MSc, Nicole Rotmensz, MSc, Maria Giulia Zampino, MD, Nicola Fazio, MD, Franco Orsi, MD

Published in: Annals of Surgical Oncology | Issue 12/2014

Abstract

Background

No randomized trials have so far investigated the cost effectiveness of different methods for implantation and use of central venous ports in oncology patients.

Patients and Methods

Overall, 403 patients eligible for receiving intravenous chemotherapy for solid tumours were randomly assigned to implantation of a single type of port, either through a percutaneous landmark access to the internal jugular vein, an ultrasound (US)-guided access to the subclavian vein, or a surgical cut-down access through the cephalic vein at the deltoid-pectoralis groove. Insertion and maintenance costs were estimated by obtaining the charges for an average implant and use, while the costs of the management of complications were analytically assessed. The total cost was defined as the purchase cost plus the insertion cost plus the maintenance cost plus the cost of treatment of the complications, if any.

Results

A total of 401 patients were evaluable—132 with the internal jugular vein, 136 with the subclavian vein and 133 with the cephalic vein access. No differences were found for the rate of early complications. The US-guided subclavian insertion site had significantly lower failures. Infections occurred in 1, 3, and 3 patients (internal jugular, subclavian, and cephalic access, respectively; p = 0.464), whereas venous thrombosis was observed in 15, 8, and 11 patients, respectively (p = 0.272). Mean cost for purchase, implantation, diagnosis and treatment of complications in each patient was €2,167.85 for subclavian US-guided, €2,335.87 for cephalic, and €2,384.10 for internal jugular access, respectively (p = 0.0001).

Conclusion

US real-time guidance to the subclavian vein resulted in the most cost-effective method of central venous port placement and use.

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Title: Cost Effectiveness of Different Central Venous Approaches for Port Placement and Use in Adult Oncology Patients: Evidence From a Randomized Three-Arm Trial
Authors: Roberto Biffi, MD
Simonetta Pozzi, MD
Guido Bonomo, MD
Paolo Della Vigna, MD
Lorenzo Monfardini, MD
Davide Radice, MSc
Nicole Rotmensz, MSc
Maria Giulia Zampino, MD
Nicola Fazio, MD
Franco Orsi, MD
Publication date: 01-11-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 12/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3784-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cost Effectiveness of Different Central Venous Approaches for Port Placement and Use in Adult Oncology Patients: Evidence From a Randomized Three-Arm Trial

Abstract

Background

Patients and Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusion

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