Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Gleueler Str. 176-178, 50935, Cologne, Germany.
Department of Anaesthesiology, Intensive Care Medicine, and Pain Therapy, Helios Hospital Krefeld, Lutherplatz 40, 47805, Krefeld, Germany.
BMC Anesthesiol. 2019 Apr 9;19(1):51. doi: 10.1186/s12871-019-0719-5.
Ultrasound guidance for central venous catheterization is a commonly used alternative to the conventional landmark method. Because from the German perspective, the cost-effectiveness of ultrasound guidance is unclear, this study examined the cost-effectiveness of ultrasound guidance versus the landmark method for adults undergoing a central venous catheterization.
A decision-tree based model was built to estimate the costs of averted catheter-related complications. Clinical data (e.g. arterial puncture, failed attempts) were obtained from a Cochrane review and a randomized controlled trial, whilst information about cost parameters were taken from a German hospital of maximum care. The analysis was conducted from the perspective of the German Statutory Health Insurance. Results were presented as incremental cost-effectiveness ratios. To assess the parameter uncertainty, several sensitivity analyses were performed (deterministic, probabilistic and with regard to the model structure).
Our analysis revealed that ultrasound guidance resulted in fewer complications per person (0.04 versus 0.17 for the landmark method) and was less expensive (€51 versus €230 for the landmark method). Results were robust to changes in the model parameters and in the model structure. Whilst our model population reflected approximately 49% of adults undergoing a central venous catheterization cannulation per year, structural sensitivity analyses (e.g. extending the study cohort to patients at higher baseline risk of complications, pediatric patients, or using real-time/indirect catheterization) indicated the cost-effectiveness of ultrasound guidance for a broader spectrum of patients. The results should be interpreted by considering the assumptions (e.g. target population) and approximations (e.g. cost parameters) underpinning the model.
Ultrasound guidance for central venous catheterization averts more catheter-related complications and may save the resources of the German Statutory Health Insurance compared with landmark method.
超声引导下中心静脉置管术是一种常用的替代传统地标方法。由于从德国的角度来看，超声引导的成本效益尚不清楚，因此本研究检查了超声引导与地标方法在成人中心静脉置管中的成本效益。
建立了一个决策树模型来估计避免导管相关并发症的成本。临床数据（例如动脉穿刺、尝试失败）来自 Cochrane 综述和一项随机对照试验，而有关成本参数的信息则来自一家德国最大护理医院。分析从德国法定健康保险的角度进行。结果以增量成本效益比表示。为了评估参数不确定性，进行了几项敏感性分析（确定性、概率性和针对模型结构）。
我们的分析表明，超声引导每人均可减少并发症（地标法为 0.04，超声法为 0.17），且费用更低（地标法为 230 欧元，超声法为 51 欧元）。结果对模型参数和模型结构的变化具有稳健性。虽然我们的模型人群反映了每年接受中心静脉置管插管的成年人约 49%，但结构敏感性分析（例如将研究队列扩展到并发症基线风险较高的患者、儿科患者或使用实时/间接置管）表明，超声引导对于更广泛的患者群体具有成本效益。在考虑模型基础的假设（例如目标人群）和近似值（例如成本参数）的情况下，应解释这些结果。
与地标法相比，超声引导下中心静脉置管术可避免更多与导管相关的并发症，并可能节省德国法定健康保险的资源。
