Heparin lock and KiteLock comparison
Abstract:
Introduction: Central line-associated bloodstream infections (CLABSIs) are the most common complication in children with intestinal failure (IF) receiving home parenteral nutrition (PN), leading to significant morbidity and mortality, prolonged hospital admissions and higher healthcare costs. KiteLock, a central line lock solution, has been shown to be effective in preventing CLABSIs, compared to heparin lock. We aimed to assess the cost-utility of KiteLock compared to heparin lock in children with IF from the Ontario healthcare payer perspective.
Method: We constructed a Markov model comprised of the following mutually exclusive health states: PN-dependence, enteral autonomy (EA), post-transplantation PN-dependence, post-transplantation EA, and death. The base case was a 12-month-old child with IF on PN, and the time horizon was lifelong. We evaluated the costs (in CAD) and utility (in quality-adjusted life years [QALYs]) of KiteLock versus heparin lock. Model parameters were obtained from published literature and institutional data. Outcome measures were EA autonomy, intestinal transplantation, death, lifetime costs and QALYs, and incremental cost-effectiveness ratios. We performed one-way and two-way deterministic sensitivity analyses, as well as threshold and scenario analyses.
Results: KiteLock was found to dominate compared to heparin lock in the Markov model, since it was more effective and less expensive (ICER of -CAD$14,758/QALY gained). Patients on KiteLock had greater probability of achieving EA and lower probability of death. Deterministic sensitivity analysis revealed our model to be sensitive to the rate of CLABSIs with heparin and the rate of CLABSIs with KiteLock.
Conclusions: We found KiteLock to be cost-effective in preventing CLABSIs in paediatric IF. Larger studies assessing the long-term effectiveness and safety profile of KiteLock in children with IF, as well as paediatric IF-specific health utilities are needed.
Reference:
Gattini D, Yan H, Belza C, Avitzur Y, W Wales P O-46: Cost-utility of Kitelock in Preventing Central Line-associated Blood Stream Infections in Children with Intestinal Failure: A Markov Model. Transplantation. 2021 Jul 1;105(7S):S24. doi: 10.1097/01.tp.0000757652.76380.b8. PMID: 34792977.