[Economic analysis of peripherally inserted central venous catheters (PICC), inserted by nursing staff, in cancer and hematological patients]

Bayón Yusta JC, Gutiérrez Iglesias A, Galnares Cordero L, Moraza Dulanto I, Armenteros Yeguas V, Tomas López A, Mateos del Pino M
Record ID 32018000505
Original Title: Análisis económico de los catéteres venosos centrales de inserción periférica (PICC) insertados por personal de enfermería en pacientes oncológicos y hematológicos
Authors' objectives: Carry out an economic analysis to know the cost of peripherally inserted central venous catheters, inserted by nursing staff belonging to the intravenous therapy teams (ITT) in cancer-hematological patients.
Authors' results and conclusions: 1,219 PICCs were inserted, between 11 June 2010 and 11 December 2015, in 1,3081 cancer-hematological patients. Of the total number of PICCs inserted by TTI nursing staff, 96.88% were successfully implemented, and the average time of use of these PICCs was 156.4 days. Of the successfully inserted PICCs, 82.81% were removed due to end of treatment or death of the patient. The highest incidence rates per 1,000 days of catheter resulted from accidental extraction complication (0.67), thrombosis (0.48) and bacteremia (0.34). For the successfully inserted PICCs, the direct health costs that the SNS had to cope with were: cost of insertion of €240.15, maintenance for average time of use of €247.21, complications of €744.68, and removal of €5.11; whilst the direct health costs paid by the patient and/or relatives amounted to €329.79. For the PICCs that were not successfully inserted, the direct health cost corresponding to the SNS was €480.30. In agreement with the decision model carried out, the cost of the PICC for its average time of use, of a cancer-hematological patient, was €545. Thanks to the univariant sensitivity analysis performed, we could observe that the variables that had the greatest influence on the result were, the time that the PC nursing staff spent on performing maintenance on the PICC and the cost of the ultrasound scan. CONCLUSIONS In agreement with the cost analysis performed, based on the data provided by the TTI nursing staff of the Integrated Health Organization of Araba Hospital Universitario, the perspective used and the defined time horizon, the cost of a PICC inserted into cancer-hematological patients by nursing staff belonging to a TTI, for an average time of use of 156 days, is €545. The variables that must be controlled to achieve a decrease in the calculated cost are: time that PC nursing staff spend on the maintenance of the PICC, the cost of the ultrasound scan, the probability of the complication of thrombosis arising, and the cost of the catheter kit.
Authors' methods: In order to know the cost of the PICCs inserted by nursing staff, belonging to ITTs, in cancer-hematological patients for the average time of use, an economic assessment, cost analysis, was performed from a social perspective and for a short-term time horizon. The necessary data required were obtained from the PICC database prepared by nursing staff from the TTI of the OSI (integrated health organization) of Araba Hospital Universitario. The micro-cost method was used to calculate the cost of the PICCs. As the social perspective was adopted in this study, the calculation was made for PICCs that were both successfully inserted and those that were not by TTI nursing staff, including both the direct health costs that the National Health System (Spanish acronym, SNS) had to cope with, - in other words, the cost of insertion, of maintenance, of complications associated with use and removal -, and the direct health costs paid by the patient and/or relatives during the treatment (cost of necessary medications to cope with complications). Neither indirect costs (loss of productivity, caregivers, etc….), nor intangible direct costs (patient’s pain and suffering) were included in the calculation. An analytical decision model, decision tree, was developed on an Excel spreadsheet, to calculate the cost of the PICCs for their average time of use. This cost was obtained in agreement with the probabilities and costs, valued in 2015 Euros, calculated for each branch of the model. A univariant sensitivity analysis was conducted to verify the robustness and reliability of the results obtained. The sensitivity analysis was represented by means of a tornado diagram.
Project Status: Completed
Year Published: 2016
English language abstract: An English language summary is available
Publication Type: Other
Country: Spain
MeSH Terms
  • Catheterization, Peripheral
  • Central Venous Catheters
  • Nursing Staff
  • Oncology Service, Hospital
  • Oncology Nursing
  • Hematology
  • Cost-Benefit Analysis
  • Cost Effectiveness
  • Central Venous Catheters
  • Peripheral Catheterization
  • PICC
  • Peripheral Venous Catheterization
  • Intravenous Administration
  • Patient Care Team
  • Nursing Team
  • Hematology
  • Medical Oncology
  • Oncología Médica
  • Hematología
  • Grupo de Enfermería
  • Grupo de Atención al Paciente
  • Administración Intravenosa
  • Cateterismo Periférico
  • Análisis Costo-Beneficio
  • Análisis Coste-Efectividad
Organisation Name: Basque Office for Health Technology Assessment
Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz
Contact Name: Lorea Galnares-Cordero
Contact Email: lgalnares@bioef.eus

Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government

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