The Use of Indwelling Pleural Catheters for the Management of Malignant Pleural Effusion - Direct Costs in a Dutch Hospital

Abstract

Background: Indwelling pleural catheters (IPCs) are increasingly used in the treatment of malignant pleural effusion (MPE). In general, these catheters have been reported to manage MPE efficiently. Unfortunately, insurance companies in the Netherlands do not reimburse these catheters in either first-line treatment or following failed talc pleurodesis. Objectives: Investigation of direct costs of IPC placement. Methods: Retrospective analysis of a prospectively collected database. Direct costs for both catheters and vacuum bottles were calculated. Indicators for indirect costs such as adverse events and complications and the need for additional home care for drainage were registered. Results: Mean costs for IPC amounted to EUR 2,173 and were different between tumor types - mesothelioma: EUR 4,028, breast: EUR 2,204, lung: EUR 1,146 and other: EUR 1,841; p = 0.017. Four patients were admitted to hospital for treatment of complications. Mean costs for IPC placement was similar when inserted as frontline treatment and after failed pleurodesis. Approximately 75% of patients did not need any help from specialized home care. Conclusion: Direct costs for IPC placement turn out to be acceptable when compared with estimated hospitalization costs for pleurodesis treatment. Randomized controlled trials have to be performed to compare the cost-effectiveness of IPCs compared to pleurodesis.

Complications of indwelling pleural catheter use and their management

“…A retrospective Dutch study found that the direct costs of IPC and drainage consumables were comparable to the estimated hospitalisation costs for pleurodesis, but did not include indirect costs 55. Early hospital charges were lowest when the IPC was inserted on an outpatient basis, compared with inpatient IPC insertion or doxycycline pleurodesis, however, long-term hospital charges did not differ significantly 35.…”

Management of Malignant Pleural Effusion

“…36 A Dutch study, which estimated TPC costs from a health care facility's perspective, also showed that costs were similar to the hospitalization-driven costs associated with talc pleurodesis. 37 That study did not directly estimate TS or TP costs, however, and also did not estimate outcomes. No prior study evaluated RPP.…”

Management of malignant pleural effusions in patients with trapped lung with indwelling pleural catheter: how to do it

“…The cost of an IPC may appear as an issue, mainly due to the cost of the device and the single-use vacuum bottles. However, in spite of these factors, IPC has been found to be the most cost-effective method since the duration of hospital stay is shorter or avoided (17)(18)(19)(20)(21)(22).…”