Economic Evaluation of Ultrasound-guided Central Venous Catheter Confirmation vs Chest Radiography in Critically Ill Patients: A Labor Cost Model

Abstract

Introduction: Despite evidence suggesting that point-of-care ultrasound (POCUS) is faster and non-inferior for confirming position and excluding pneumothorax after central venous catheter (CVC) placement compared to traditional radiography, millions of chest radiographs (CXR) are performed annually for this purpose. Whether the use of POCUS results in cost savings compared to CXR is less clear but could represent a relative advantage in implementation efforts. Our objective in this study was to evaluate the labor cost difference for POCUS-guided vs CXR-guided CVC position confirmation practices. Methods: We developed a model to evaluate the per patient difference in labor cost between POCUS-guided vs CXR-guided CVC confirmation at our local urban, tertiary academic institution. We used internal cost data from our institution to populate the variables in our model. Results: The estimated labor cost per patient was $18.48 using CXR compared to $14.66 for POCUS, resulting in a net direct cost savings of $3.82 (21%) per patient using POCUS for CVC confirmation. Conclusion: In this study comparing the labor costs of two approaches for CVC confirmation, the more efficient alternative (POCUS-guided) is not more expensive than traditional CXR. Performing an economic analysis framed in terms of labor costs and work efficiency may influence stakeholders and facilitate earlier adoption of POCUS for CVC confirmation.

Are routine chest radiographs still indicated after central line insertion? A scoping review

“…Our search identified and screened 4071 articles, of which 117 full-text articles were accessed for eligibility (Figure 1). 3,6–11,13,14,17–20,29–57 We retained 41 articles based on prespecified criteria for inclusion (Table 1). Regarding ultrasound guided placement and confirmation methods, 13 articles examined cardiac/vascular methods; 5 examined isolated contrast-enhanced ultrasonography (CEUS); 7 examined isolated rapid atrial swirl sign (RASS); and 13 examined combined/integrated methods (Table 1).…”

Comments on “Economic Evaluation of Ultrasound-guided Central Venous Catheter Confirmation vs Chest Radiography in Critically Ill Patients: A Labor Cost Model”

“…We would like to commend Dr. Ablordeppey and her colleagues for their recent publication in the Western Journal of Emergency Medicine evaluating the comparative labor cost of central venous catheter confirmation via point-of-care ultrasound (POCUS) vs traditional chest radiography (CXR). 1 To our knowledge, this well-designed article was the first to analyze in detail the direct labor cost of using POCUS-guided confirmation for central lines vs traditional CXR confirmation. We were surprised when the authors reported that the POCUS-guided method was only $3.82 cheaper than the CXR method.…”

Response to “Comments on Economic Evaluation of Ultrasound-guided Central Venous Catheter Confirmation vs Chest Radiography in Critically Ill Patients: A Labor Cost Model”

“…We would like to thank Austin et al 1 for their interest in our article comparing labor costs of two approaches to central venous catheter (CVC) confirmation, 2 recently published in the Western Journal of Emergency Medicine . In their letter to the editor, they acknowledge that the point-of-care ultrasound (POCUS)-guided confirmation method offers direct and potential indirect cost benefits when compared with the chest radiograph (CXR) method.…”