Vélez-Bonilla Mariana, Hernández-Flórez Catalina, Solano-Felizzola Allan, Amado-Garzón Sandra B, Rosselli Diego
Department of Internal Medicine - Hospital Universitario San Ignacio, Bogotá, Colombia. E-mail:
Department of Internal Medicine - Hospital Universitario San Ignacio, Bogotá, Colombia. Hospital at home. Medicine - Hospital Universitario San Ignacio, Bogotá, Colombia E-mail:
Rev Cuid. 2025 May 1;16(2):e4124. doi: 10.15649/cuidarte.4124. eCollection 2025 May-Aug.
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.
This study conducted an economic evaluation comparing PICC and SPC for patient outpatient parenteral antibiotic therapy.
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).
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.
PICC was more effective in reducing minor complications. Costs decreased with nurse-led insertions and lower catheter material costs.
Increasing PICC use for extended treatments could reduce overall costs and lower ICERs, highlighting their potential economic advantage despite higher initial expenses.
居家医院项目依靠血管通路装置来安全地给予肠外抗菌药物。虽然指南推荐使用经外周静脉穿刺中心静脉导管（PICC）进行≥14天的治疗，但短外周导管（SPC）却经常被取而代之。比较这些装置及其并发症的成本效益研究有限。
本研究进行了一项经济评估，比较PICC和SPC用于患者门诊肠外抗生素治疗的情况。
对导管并发症发生率进行文献综述，共获得1053篇论文，经独立同行评审后缩减至18篇。咨询了专家，并编制了导管使用所需物品清单以确定成本。基于并发症发生率和成本建立了决策树模型。使用增量成本效益比（ICER）、单因素敏感性分析（龙卷风图）和多因素敏感性分析（蒙特卡洛模拟）对结果进行分析。
两种装置的主要并发症相似，但SPC的轻微并发症更常见。PICC参考案例假设放射科医生/护士插入比例为50%-50%、导管成本（74.7美元）、治疗时间≤15天以及并发症发生率。与PICC相关的较高成本与导管材料和放射科医生插入有关。多因素分析显示，假设PICC价格降低50%，由护士主导插入比例为90%时ICER为492美元，100%由护士主导插入时ICER为243美元。
PICC在减少轻微并发症方面更有效。成本随着由护士主导插入以及较低的导管材料成本而降低。
增加PICC在延长治疗中的使用可降低总体成本并降低ICER，这突出了其尽管初始费用较高但潜在的经济优势。
