Economic analysis: PICC versus short catheter for prolonged home antibiotic therapy

TL;DR

This study compares the cost-effectiveness of PICC and short catheters for long-term home antibiotic therapy, finding that PICCs may be more economical despite higher initial costs.

Contribution

The study introduces a novel economic evaluation model comparing PICC and SPC for outpatient antibiotic therapy, incorporating sensitivity analyses.

Findings

PICC was more effective in reducing minor complications compared to short peripheral catheters.

Costs decreased with nurse-led PICC insertions and lower catheter material costs.

Multivariate analysis showed lower ICERs with nurse-led insertions and reduced PICC prices.

Abstract

Hospital-at-home programs rely on vascular access devices for secure administration of parenteral antimicrobials. While guidelines recommend peripherally inserted central catheters (PICC) for treatments ≥14 days, short peripheral catheters (SPC) are often used instead. Cost-effectiveness studies comparing these devices and their complications are limited.

This study conducted an economic evaluation comparing PICC and SPC for patient outpatient parenteral antibiotic therapy.

A literature review of catheter complication frequencies yielded 1053 papers, narrowed to 18 after independent peer review. Experts were consulted, and a list of items required for catheter use was compiled to determine costs. A decision tree model was developed based on complication frequencies and costs. Results were analyzed using incremental cost-effectiveness ratios (ICER), univariate sensitivity analysis (tornado diagram), and multivariate sensitivity analysis (Monte Carlo simulation).

Major complications were similar between devices, but minor complications were more frequent with SPC. The PICC reference case assumed 50%-50% radiologist/nurse insertion, catheter cost ($74,7), ≤15-day treatment, and complication prevalence. Higher costs associated with PICC were linked to catheter material and radiologist insertion. Multivariate analysis showed ICERs of $49,2 with 90% nurse-led insertion and $24,3 with 100% nurse-led insertions, assuming a 50% PICC price reduction.

PICC was more effective in reducing minor complications. Costs decreased with nurse-led insertions and lower catheter material costs.

Increasing PICC use for extended treatments could reduce overall costs and lower ICERs, highlighting their potential economic advantage despite higher initial expenses.

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