Evaluation of cost-effectiveness from the funding body’s point of view of ultrasound-guided central venous catheter insertion compared with the conventional technique

Abstract

ObjectiveTo evaluate the cost-effectiveness, from the funding body's point of view, of real-time ultrasound-guided central venous catheter insertion compared to the traditional method, which is based on the external anatomical landmark technique.MethodsA theoretical simulation based on international literature data was applied to the Brazilian context, i.e., the Unified Health System (Sistema Único de Saúde - SUS). A decision tree was constructed that showed the two central venous catheter insertion techniques: real-time ultrasonography versus external anatomical landmarks. The probabilities of failure and complications were extracted from a search on the PubMed and Embase databases, and values associated with the procedure and with complications were taken from market research and the Department of Information Technology of the Unified Health System (DATASUS). Each central venous catheter insertion alternative had a cost that could be calculated by following each of the possible paths on the decision tree. The incremental cost-effectiveness ratio was calculated by dividing the mean incremental cost of real-time ultrasound compared to the external anatomical landmark technique by the mean incremental benefit, in terms of avoided complications.ResultsWhen considering the incorporation of real-time ultrasound and the concomitant lower cost due to the reduced number of complications, the decision tree revealed a final mean cost for the external anatomical landmark technique of 262.27 Brazilian reals (R$) and for real-time ultrasound of R$187.94. The final incremental cost of the real-time ultrasound-guided technique was -R$74.33 per central venous catheter. The incremental cost-effectiveness ratio was -R$2,494.34 due to the pneumothorax avoided.ConclusionReal-time ultrasound-guided central venous catheter insertion was associated with decreased failure and complication rates and hypothetically reduced costs from the view of the funding body, which in this case was the SUS.

Cost-effectiveness-analysis of ultrasound guidance for central venous catheterization compared with landmark method: a decision-analytic model

“…In the base case, the use of UG for a central venous catheterization compared with LM reduces the costs by €179 per procedure and is associated with on average 0.14 less complications. In line with previous studies from other health systems [10, 11], our results confirm, the use of UG for central venous catheterization being more effective in averting complications and less costly than the LM. These results did not change when various sensitivity analyses were applied.…”

“…To estimate the averted complications, an event was coded as ‘0’ and no event as ‘1’. The time horizon of the model covered a period of 1 year because clinical and monetary consequences resulting from a central venous catheterization beyond this time are unlikely [10, 11]. The model was built and calculated with TreeAge Pro 2017© (Williamstown, Massachusetts).…”

“…In order to ensure that the model is implemented as intended, estimates of cost data were verified by accounting experts of the German Helios Hospital Krefeld [19] (technical validity). Furthermore, we compared the model structure and results of this model to that of available cost-effectiveness models [10, 11] from the UK and Brazilian health care systems in this field (cross-validation).…”

“…International studies have analyzed the cost-effectiveness of UG versus LM and have shown the UG to be a cost-saving catheterization strategy [10, 11]. In Germany more than a half million central venous catheters are placed annually [12], whilst evidence on economic impacts of using UG is still lacking.…”

Tempo de permanência do curativo do cateter central de inserção periférica em neonatos

“…Os métodos de punção são dois: direto, quando a veia é palpada e puncionada; e indireto, quando se punciona lateralmente reposicionando dentro da veia (Phillips, 2001). Atualmente, há uma crescente procura para capacitação dos enfermeiros para utilização do Ultrassom na passagem do CCIP e outros dispositivos vasculares (Noritomi et al, 2016).…”