Cargando…
Cost-utility analysis of different venous access devices in breast cancer patients: a decision-based analysis model
BACKGROUND: Venous access devices commonly used in clinical practice for long-term chemotherapy of breast cancer include central venous catheters (CVCs), peripherally inserted central venous catheters (PICCs), and implantable venous access ports (IVAPs). CVCs and PICCs are less costly to place but h...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10190063/ https://www.ncbi.nlm.nih.gov/pubmed/37194042 http://dx.doi.org/10.1186/s12913-023-09517-1 |
_version_ | 1785043209892659200 |
---|---|
author | Chen, Na Yang, Qing Li, Yin Feng Guo, Qin Huang, De Yu Peng, Jia Ling |
author_facet | Chen, Na Yang, Qing Li, Yin Feng Guo, Qin Huang, De Yu Peng, Jia Ling |
author_sort | Chen, Na |
collection | PubMed |
description | BACKGROUND: Venous access devices commonly used in clinical practice for long-term chemotherapy of breast cancer include central venous catheters (CVCs), peripherally inserted central venous catheters (PICCs), and implantable venous access ports (IVAPs). CVCs and PICCs are less costly to place but have a higher complication rate than IVAPs. However, there is a lack of cost-utility comparisons among the three devices. The aim of this study was to assess the cost-effectiveness of three catheters for long-term chemotherapy in breast cancer patients. METHODS: This study used propensity score matching (PSM) to establish a retrospective cohort. Decision tree models were used to compare the cost-effectiveness of three different intravenous lines in breast cancer chemotherapy patients. Cost parameters were derived from data extracted from the outpatient and inpatient charging systems, and total costs included costs of placement, maintenance, extraction, and handling of complications; utility parameters were derived from previous cross-sectional survey results of the research group; and complication rates were derived from breast cancer catheterization patient information as well as follow-up information. Quality-adjusted life years (QALYs) were measured for efficacy outcomes. Incremental cost-effectiveness ratios (ICERs) were used to compare the three strategies. To assess uncertainty in model parameters, sensitivity analyses (univariate sensitivity analysis and probabilistic sensitivity analysis) were performed. RESULTS: A total of 10,718 patients (3780 after propensity score matching) were included. IVAPs had the smallest cost-utility ratio, and PICCs had the largest cost-utility ratio when left in place for more than 12 months. The incremental cost-utility ratio of PICC to CVC was $2375.08/QALY, IVAP to PICC was $522.01/QALY, and IVAP to CVC was $612.98/QALY. Incremental cost-effectiveness ratios showed that IVAPs were more effective than CVCs and PICCs. Model regression analysis showed that the IVAP was recommended as the best regimen regardless of the catheter indwelling time (6 months, 12 months or more than 12 months). The reliability and stability of the model were verified by single-factor sensitivity analysis and Monte Carlo simulation (probabilistic sensitivity analysis). CONCLUSION: This study provides economic evidence for the selection of vascular access in breast cancer chemotherapy patients. In the case of limited resources in China, establishing a decision tree model comparing the cost-effectiveness of three vascular access devices for breast cancer chemotherapy patients determined that the IVAP was the most cost-effective regimen. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-09517-1. |
format | Online Article Text |
id | pubmed-10190063 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-101900632023-05-18 Cost-utility analysis of different venous access devices in breast cancer patients: a decision-based analysis model Chen, Na Yang, Qing Li, Yin Feng Guo, Qin Huang, De Yu Peng, Jia Ling BMC Health Serv Res Research BACKGROUND: Venous access devices commonly used in clinical practice for long-term chemotherapy of breast cancer include central venous catheters (CVCs), peripherally inserted central venous catheters (PICCs), and implantable venous access ports (IVAPs). CVCs and PICCs are less costly to place but have a higher complication rate than IVAPs. However, there is a lack of cost-utility comparisons among the three devices. The aim of this study was to assess the cost-effectiveness of three catheters for long-term chemotherapy in breast cancer patients. METHODS: This study used propensity score matching (PSM) to establish a retrospective cohort. Decision tree models were used to compare the cost-effectiveness of three different intravenous lines in breast cancer chemotherapy patients. Cost parameters were derived from data extracted from the outpatient and inpatient charging systems, and total costs included costs of placement, maintenance, extraction, and handling of complications; utility parameters were derived from previous cross-sectional survey results of the research group; and complication rates were derived from breast cancer catheterization patient information as well as follow-up information. Quality-adjusted life years (QALYs) were measured for efficacy outcomes. Incremental cost-effectiveness ratios (ICERs) were used to compare the three strategies. To assess uncertainty in model parameters, sensitivity analyses (univariate sensitivity analysis and probabilistic sensitivity analysis) were performed. RESULTS: A total of 10,718 patients (3780 after propensity score matching) were included. IVAPs had the smallest cost-utility ratio, and PICCs had the largest cost-utility ratio when left in place for more than 12 months. The incremental cost-utility ratio of PICC to CVC was $2375.08/QALY, IVAP to PICC was $522.01/QALY, and IVAP to CVC was $612.98/QALY. Incremental cost-effectiveness ratios showed that IVAPs were more effective than CVCs and PICCs. Model regression analysis showed that the IVAP was recommended as the best regimen regardless of the catheter indwelling time (6 months, 12 months or more than 12 months). The reliability and stability of the model were verified by single-factor sensitivity analysis and Monte Carlo simulation (probabilistic sensitivity analysis). CONCLUSION: This study provides economic evidence for the selection of vascular access in breast cancer chemotherapy patients. In the case of limited resources in China, establishing a decision tree model comparing the cost-effectiveness of three vascular access devices for breast cancer chemotherapy patients determined that the IVAP was the most cost-effective regimen. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-09517-1. BioMed Central 2023-05-16 /pmc/articles/PMC10190063/ /pubmed/37194042 http://dx.doi.org/10.1186/s12913-023-09517-1 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Chen, Na Yang, Qing Li, Yin Feng Guo, Qin Huang, De Yu Peng, Jia Ling Cost-utility analysis of different venous access devices in breast cancer patients: a decision-based analysis model |
title | Cost-utility analysis of different venous access devices in breast cancer patients: a decision-based analysis model |
title_full | Cost-utility analysis of different venous access devices in breast cancer patients: a decision-based analysis model |
title_fullStr | Cost-utility analysis of different venous access devices in breast cancer patients: a decision-based analysis model |
title_full_unstemmed | Cost-utility analysis of different venous access devices in breast cancer patients: a decision-based analysis model |
title_short | Cost-utility analysis of different venous access devices in breast cancer patients: a decision-based analysis model |
title_sort | cost-utility analysis of different venous access devices in breast cancer patients: a decision-based analysis model |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10190063/ https://www.ncbi.nlm.nih.gov/pubmed/37194042 http://dx.doi.org/10.1186/s12913-023-09517-1 |
work_keys_str_mv | AT chenna costutilityanalysisofdifferentvenousaccessdevicesinbreastcancerpatientsadecisionbasedanalysismodel AT yangqing costutilityanalysisofdifferentvenousaccessdevicesinbreastcancerpatientsadecisionbasedanalysismodel AT liyinfeng costutilityanalysisofdifferentvenousaccessdevicesinbreastcancerpatientsadecisionbasedanalysismodel AT guoqin costutilityanalysisofdifferentvenousaccessdevicesinbreastcancerpatientsadecisionbasedanalysismodel AT huangdeyu costutilityanalysisofdifferentvenousaccessdevicesinbreastcancerpatientsadecisionbasedanalysismodel AT pengjialing costutilityanalysisofdifferentvenousaccessdevicesinbreastcancerpatientsadecisionbasedanalysismodel |