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

INTRODUCTION

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.

OBJECTIVE

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

MATERIALS AND METHODS

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).

RESULTS

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.

DISCUSSION

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

CONCLUSION

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