Cost‐effectiveness of indwelling pleural catheter compared with talc in malignant pleural effusion

Abstract

Background and objective: Malignant pleural effusion is associated with morbidity and mortality. A randomized controlled trial previously compared clinical outcomes and resource use with indwelling pleural catheter (IPC) and talc pleurodesis in this population. Using unpublished quality of life data, we estimate the cost-effectiveness of IPC compared with talc pleurodesis. Methods: Healthcare utilization and costs were captured during the trial. Utility weights produced by the EuroQol Group five-dimensional three-level questionnaire and survival were used to determine qualityadjusted life-years (QALYs) gained. The incremental cost-effectiveness ratio (ICER) was calculated over the 1-year trial period. Sensitivity analysis used patient survival data and modelled additional nursing time required per week for catheter drainage. Results: Utility scores, cost and QALYs gained did not differ significantly between groups. The ICER for IPC compared with talc was favorable at $US10 870 per QALY gained. IPC was less costly with a probability exceeding 95% of being cost-effective when survival was <14 weeks, and was more costly when 2-h nursing time per week was assumed for catheter drainage. Conclusion: IPC is cost-effective when compared with talc, although substantial uncertainty exists around this estimate. IPC appears most cost-effective in patients with limited survival. If significant nursing time is required for catheter drainage, IPC becomes less likely to be cost-effective. Either therapy may be considered

Year in review 2017: Interventional pulmonology, lung cancer, pleural disease and respiratory infections

“…Using utility and cost data directly from the landmark TIME2 trial, this study examined whether and when one of the two therapeutic alternatives was more cost‐effective. The study results help bring additional clarity on this subject, with indwelling pleural catheter standing out as a more cost‐effective for all patients with an estimated survival <14 weeks and chemical pleurodesis appearing to be more cost‐effective for patients with longer estimated survival who would be expected to need two or more hours per week of nursing care should they undergo catheter placement …”

“…The study results help bring additional clarity on this subject, with indwelling pleural catheter standing out as a more cost-effective for all patients with an estimated survival <14 weeks and chemical pleurodesis appearing to be more cost-effective for patients with longer estimated survival who would be expected to need two or more hours per week of nursing care should they undergo catheter placement. 57 Malignant effusion-innocent bystander or wilful accomplice in mesothelioma pathobiology?…”

Managing malignant pleural effusion

“…They have been found to be more cost-effective than talc pleurodesis in patients not expected to live long (survival < 14 weeks). 16 Patients with an indwelling pleural catheter can receive chemotherapy, and concurrent treatment does not increase risk of infection. 17 And a systematic review 18 found a 46% rate of autopleurodesis at a median of 52 days after insertion of an indwelling pleural catheter.…”

Contemporary best practice in the management of malignant pleural effusion

“…Evidence using United Kingdom costings has suggested that the overall mean costs per year for IPC were not significantly different when compared with ICD with pleurodesis, although IPC became a significantly cheaper option in those who survived <14 weeks. 35 , 36 …”