Chemotherapy CVAD economic evaluation
Abstract:
Objectives: Patients undergoing long-term anti-cancer therapy typically require one of three venous access devices (VADs): HICK, PICC, or PORT. Recent evidence has shown PORT is safer and improves patient satisfaction. However, PORT did not show improvement in quality-adjusted life years (QALYs) and was more expensive. Decisions regarding cost-effectiveness in the UK are typically informed by a cost-per-QALY metric. However, this approach is limited in its ability to capture the full range of relevant outcomes, especially in the context of medical devices. This study assessed the potential cost-effectiveness of HICK, PICC and PORT in routine clinical practice.
Methods: Cost-consequence analysis to determine the trade-offs between the following outcomes: complication, infection, non-infection, chemotherapy interruption, unplanned device removals, health utilities, device insertion cost, follow-up cost, and total cost, using data from the CAVA clinical trial. We conducted Value of Implementation analysis of a PORT service.
Results: PORT was superior in terms of overall complication rate, compared with both HICK (IRR: 0.422 (95% CI: 0.286 to 0.622)) and PICC (IRR: 0.295 (95% CI: 0.189 to 0.458)) and less likely to lead to an unplanned device removal. There was no difference in chemotherapy interruption or health utilities. Total cost with device in situ was lower on PORT, compared with HICK (£-98.86 (95% CI: -189.20 to -8.53)) and comparable with PICC -£48.57 (95% CI: -164.99 to 67.86)). Value of Implementation analysis found that PORT was likely to be considered cost-effective within the NHS.
Conclusion: Decision makers should consider including PORT within the suite of VADs available within in the NHS.
Heggie R, Jaiswal N, McCartney E, Moss J, Menne T, Jones B, Boyd K, Soulis E, Hawkins N, Wu O. Central venous access devices for the delivery of systemic anticancer therapy: an economic evaluation. Value Health. 2023 Oct 14:S1098-3015(23)06148-X. doi: 10.1016/j.jval.2023.09.2996. Epub ahead of print. PMID: 37844662.