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Objective: With the widespread use of peripherally inserted central catheters, plenty of studies have compared peripherally inserted central catheters with other venous access devices to choose the most appropriate device in different clinical scenarios. Economic attributes are one of the important influencing factors in the selection of venous access devices. Several economic evaluation studies have been conducted in this area, but the evaluation methods, contents, outcomes, and quality of these economic studies have not been systematically evaluated. Therefore, we aimed to map the existing research on the economic evaluations of peripherally inserted central catheters and other venous access devices to provide economic evidence for decision-makers to choose a suitable venous access device. Second, we appraised the quality of economic evaluation studies in this area to highlight methodological weaknesses and provide an outline for the normative application of this methodology for future research. Methods: A literature search was undertaken through 11 databases from inception until 11 March 2019, to identify economic evaluation studies comparing peripherally inserted central catheters with other venous access devices. After screening articles and extracting data independently, we summarized methods, contents, and outcomes of the included studies and appraised their methodological quality using the Joanna Briggs Institute critical appraisal checklist for economic evaluations. Results: A total of 16 studies were included. Among the six studies comparing peripherally inserted central catheters with peripheral intravenous catheters, four studies performed a cost-effectiveness analysis and noted that peripherally inserted central catheters were more cost-effective than peripheral intravenous catheters. Two studies performed a cost analysis to compare peripherally inserted central catheters with peripheral intravenous catheters during the insertion and maintenance/removal periods but reached different conclusions. Seven of the included studies performed a cost analysis to compare peripherally inserted central catheters with central venous catheters. They pointed out that the catheter insertion costs of peripherally inserted central catheters were lower than those for central venous catheters in developed countries, whereas the opposite conclusion was reached in developing countries. Conversely, conclusions regarding the costs for catheter maintenance and catheter insertion and maintenance/removal were inconsistent. Six of the included studies performed a cost analysis to compare peripherally inserted central catheters with vascular access ports. They pointed out that the insertion costs of peripherally inserted central catheters were lower than those for vascular access ports, and the maintenance costs were higher than those for vascular access ports. Conversely, conclusions regarding the costs for catheter insertion and maintenance/removal were inconsistent. In addition, the methodological quality of the included studies had plenty of deficiencies, including no discounting, no sensitivity analysis, no incremental analysis, a lack of validity of costs and effectiveness, and so on. Conclusion: This scoping review highlighted the desperate paucity of economic evaluation studies of peripherally inserted central catheters and other venous access devices in amount, evaluation contents, and economic evaluation methods. The conclusions of the cost-effectiveness analysis of peripherally inserted central catheters with other venous access devices were consistent. Conversely, the conclusions of the cost analysis of peripherally inserted central catheters with other venous access devices were inconsistent mainly in the comparison of peripherally inserted central catheters with peripheral intravenous catheters, central venous catheters, and vascular access ports during the insertion and maintenance/removal periods. This review also highlighted many methodological issues of economic evaluations in this area. Therefore, it is necessary to conduct more high-quality economic evaluation studies on peripherally inserted central catheters and other venous access devices by performing cost-effectiveness analysis, costâutility analysis, or costâbenefit analysis from catheter insertion to removal to provide evidence for clinical practitioners, patients, and decision-makers to choose a suitable venous access device in different clinical scenarios.
Objective: With the widespread use of peripherally inserted central catheters, plenty of studies have compared peripherally inserted central catheters with other venous access devices to choose the most appropriate device in different clinical scenarios. Economic attributes are one of the important influencing factors in the selection of venous access devices. Several economic evaluation studies have been conducted in this area, but the evaluation methods, contents, outcomes, and quality of these economic studies have not been systematically evaluated. Therefore, we aimed to map the existing research on the economic evaluations of peripherally inserted central catheters and other venous access devices to provide economic evidence for decision-makers to choose a suitable venous access device. Second, we appraised the quality of economic evaluation studies in this area to highlight methodological weaknesses and provide an outline for the normative application of this methodology for future research. Methods: A literature search was undertaken through 11 databases from inception until 11 March 2019, to identify economic evaluation studies comparing peripherally inserted central catheters with other venous access devices. After screening articles and extracting data independently, we summarized methods, contents, and outcomes of the included studies and appraised their methodological quality using the Joanna Briggs Institute critical appraisal checklist for economic evaluations. Results: A total of 16 studies were included. Among the six studies comparing peripherally inserted central catheters with peripheral intravenous catheters, four studies performed a cost-effectiveness analysis and noted that peripherally inserted central catheters were more cost-effective than peripheral intravenous catheters. Two studies performed a cost analysis to compare peripherally inserted central catheters with peripheral intravenous catheters during the insertion and maintenance/removal periods but reached different conclusions. Seven of the included studies performed a cost analysis to compare peripherally inserted central catheters with central venous catheters. They pointed out that the catheter insertion costs of peripherally inserted central catheters were lower than those for central venous catheters in developed countries, whereas the opposite conclusion was reached in developing countries. Conversely, conclusions regarding the costs for catheter maintenance and catheter insertion and maintenance/removal were inconsistent. Six of the included studies performed a cost analysis to compare peripherally inserted central catheters with vascular access ports. They pointed out that the insertion costs of peripherally inserted central catheters were lower than those for vascular access ports, and the maintenance costs were higher than those for vascular access ports. Conversely, conclusions regarding the costs for catheter insertion and maintenance/removal were inconsistent. In addition, the methodological quality of the included studies had plenty of deficiencies, including no discounting, no sensitivity analysis, no incremental analysis, a lack of validity of costs and effectiveness, and so on. Conclusion: This scoping review highlighted the desperate paucity of economic evaluation studies of peripherally inserted central catheters and other venous access devices in amount, evaluation contents, and economic evaluation methods. The conclusions of the cost-effectiveness analysis of peripherally inserted central catheters with other venous access devices were consistent. Conversely, the conclusions of the cost analysis of peripherally inserted central catheters with other venous access devices were inconsistent mainly in the comparison of peripherally inserted central catheters with peripheral intravenous catheters, central venous catheters, and vascular access ports during the insertion and maintenance/removal periods. This review also highlighted many methodological issues of economic evaluations in this area. Therefore, it is necessary to conduct more high-quality economic evaluation studies on peripherally inserted central catheters and other venous access devices by performing cost-effectiveness analysis, costâutility analysis, or costâbenefit analysis from catheter insertion to removal to provide evidence for clinical practitioners, patients, and decision-makers to choose a suitable venous access device in different clinical scenarios.
BackgroundCentral lineâassociated bloodstream infections (CLABSI) are a serious complication in children with intestinal failure. This study assessed the incremental costs of 4% tetrasodium ethylenediaminetetraacetic acid (EDTA) compared with taurolidine lock and heparin lock per qualityâadjusted lifeâyear (QALY) gained in children with intestinal failure from the healthcare payer and societal perspective.MethodsA Markov cohort model of a 1âyearâold child with intestinal failure was simulated until the age of 17 years (time horizon), with a cycle length of 1 month. The health outcome measure was QALYs, with results expressed in terms of incremental costs and QALYs. Model parameters were obtained from published literature and institutional data. Deterministic, probabilistic, and scenario sensitivity analyses were performed.Results4% Tetrasodium EDTA was dominant (more effective and less expensive) compared with taurolidine and heparin, yielding an additional 0.17 QALYs with savings of CAD$88,277 compared with heparin, and an additional 0.06 QALYs with savings of CAD$52,120 compared with taurolidine lock from the healthcare payer perspective. From the societal perspective, 4% tetrasodium EDTA resulted in savings of CAD$90,696 compared with heparin and savings of CAD$36,973 compared with taurolidine lock.ConclusionsThis modelâbased analysis indicates that 4% tetrasodium EDTA can be considered the optimal strategy compared with taurolidine and heparin in terms of costâeffectiveness. The decision uncertainty can be reduced by conducting further research on the model input parameters. An expected value of perfect information analysis can identify what model input parameters would be most valuable to focus on.
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