Cost-Effectiveness of a Guided Peripherally Inserted Central Catheter Placement System

A Single-Center Cohort Study

Eric J. Keller, Emily Aragona, Heather Molina, Jung Lee, Riad Salem, Scott A Resnick, Howard B Chrisman, Jeremy D. Collins*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Purpose: To assess the cost-effectiveness of peripherally inserted central catheter (PICC) placements using an ultrasound and electrocardiogram-guided system versus external measurements and confirmatory chest X-rays (CXRs). Materials and Methods: Sixty-eight guided PICC placements were performed in 63 outpatients (mean age, 43 ± 13 years; 50% male) and compared to 68 propensity score-matched PICC placements (mean age, 44 ± 13 years; 56% male) performed using external measurements by the same operators. Post-placement CXRs were used to confirm final catheter tip positioning. Cohorts were compared in terms of repositioning rates, desired tip positioning rates (in the lower third of the superior vena cava or at the cavoatrial junction), and estimated cost per PICC positioned as desired using manufacturer quotes, Medicare reimbursement rates, and hourly wages for staff time. Agreement between tip positioning according to the guided system versus CXR was also assessed. Results: Guided PICC placements required less repositioning (1.5% vs 10.3%, P =.03) and resulted in more catheters positioned as desired (86.8% vs 67.6%, P =.01) than the external measurement approach. The cost per PICC positioned as desired was lower for guided placements ($318.54 vs $381.44), suggesting that the guided system was cost-effective in this clinical setting. Guided system-CXR agreement for tip position was poor (κ=0.25, P =.002) due to tips being slightly farther from the cavoatrial junction on CXR than indicated by the guided system. Conclusions: The guided PICC placement system was cost-effective in outpatients treated by a single division of interventional radiology at an academic institution.

Original languageEnglish (US)
Pages (from-to)709-714
Number of pages6
JournalJournal of Vascular and Interventional Radiology
Volume30
Issue number5
DOIs
StatePublished - May 1 2019

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Cost-Benefit Analysis
Cohort Studies
Catheters
Thorax
X-Rays
Costs and Cost Analysis
Outpatients
Interventional Radiology
Propensity Score
Superior Vena Cava
Salaries and Fringe Benefits
Medicare
Electrocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{a9c562da920a4be4a8831300cfe5ec91,
title = "Cost-Effectiveness of a Guided Peripherally Inserted Central Catheter Placement System: A Single-Center Cohort Study",
abstract = "Purpose: To assess the cost-effectiveness of peripherally inserted central catheter (PICC) placements using an ultrasound and electrocardiogram-guided system versus external measurements and confirmatory chest X-rays (CXRs). Materials and Methods: Sixty-eight guided PICC placements were performed in 63 outpatients (mean age, 43 ± 13 years; 50{\%} male) and compared to 68 propensity score-matched PICC placements (mean age, 44 ± 13 years; 56{\%} male) performed using external measurements by the same operators. Post-placement CXRs were used to confirm final catheter tip positioning. Cohorts were compared in terms of repositioning rates, desired tip positioning rates (in the lower third of the superior vena cava or at the cavoatrial junction), and estimated cost per PICC positioned as desired using manufacturer quotes, Medicare reimbursement rates, and hourly wages for staff time. Agreement between tip positioning according to the guided system versus CXR was also assessed. Results: Guided PICC placements required less repositioning (1.5{\%} vs 10.3{\%}, P =.03) and resulted in more catheters positioned as desired (86.8{\%} vs 67.6{\%}, P =.01) than the external measurement approach. The cost per PICC positioned as desired was lower for guided placements ($318.54 vs $381.44), suggesting that the guided system was cost-effective in this clinical setting. Guided system-CXR agreement for tip position was poor (κ=0.25, P =.002) due to tips being slightly farther from the cavoatrial junction on CXR than indicated by the guided system. Conclusions: The guided PICC placement system was cost-effective in outpatients treated by a single division of interventional radiology at an academic institution.",
author = "Keller, {Eric J.} and Emily Aragona and Heather Molina and Jung Lee and Riad Salem and Resnick, {Scott A} and Chrisman, {Howard B} and Collins, {Jeremy D.}",
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Cost-Effectiveness of a Guided Peripherally Inserted Central Catheter Placement System : A Single-Center Cohort Study. / Keller, Eric J.; Aragona, Emily; Molina, Heather; Lee, Jung; Salem, Riad; Resnick, Scott A; Chrisman, Howard B; Collins, Jeremy D.

In: Journal of Vascular and Interventional Radiology, Vol. 30, No. 5, 01.05.2019, p. 709-714.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cost-Effectiveness of a Guided Peripherally Inserted Central Catheter Placement System

T2 - A Single-Center Cohort Study

AU - Keller, Eric J.

AU - Aragona, Emily

AU - Molina, Heather

AU - Lee, Jung

AU - Salem, Riad

AU - Resnick, Scott A

AU - Chrisman, Howard B

AU - Collins, Jeremy D.

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Purpose: To assess the cost-effectiveness of peripherally inserted central catheter (PICC) placements using an ultrasound and electrocardiogram-guided system versus external measurements and confirmatory chest X-rays (CXRs). Materials and Methods: Sixty-eight guided PICC placements were performed in 63 outpatients (mean age, 43 ± 13 years; 50% male) and compared to 68 propensity score-matched PICC placements (mean age, 44 ± 13 years; 56% male) performed using external measurements by the same operators. Post-placement CXRs were used to confirm final catheter tip positioning. Cohorts were compared in terms of repositioning rates, desired tip positioning rates (in the lower third of the superior vena cava or at the cavoatrial junction), and estimated cost per PICC positioned as desired using manufacturer quotes, Medicare reimbursement rates, and hourly wages for staff time. Agreement between tip positioning according to the guided system versus CXR was also assessed. Results: Guided PICC placements required less repositioning (1.5% vs 10.3%, P =.03) and resulted in more catheters positioned as desired (86.8% vs 67.6%, P =.01) than the external measurement approach. The cost per PICC positioned as desired was lower for guided placements ($318.54 vs $381.44), suggesting that the guided system was cost-effective in this clinical setting. Guided system-CXR agreement for tip position was poor (κ=0.25, P =.002) due to tips being slightly farther from the cavoatrial junction on CXR than indicated by the guided system. Conclusions: The guided PICC placement system was cost-effective in outpatients treated by a single division of interventional radiology at an academic institution.

AB - Purpose: To assess the cost-effectiveness of peripherally inserted central catheter (PICC) placements using an ultrasound and electrocardiogram-guided system versus external measurements and confirmatory chest X-rays (CXRs). Materials and Methods: Sixty-eight guided PICC placements were performed in 63 outpatients (mean age, 43 ± 13 years; 50% male) and compared to 68 propensity score-matched PICC placements (mean age, 44 ± 13 years; 56% male) performed using external measurements by the same operators. Post-placement CXRs were used to confirm final catheter tip positioning. Cohorts were compared in terms of repositioning rates, desired tip positioning rates (in the lower third of the superior vena cava or at the cavoatrial junction), and estimated cost per PICC positioned as desired using manufacturer quotes, Medicare reimbursement rates, and hourly wages for staff time. Agreement between tip positioning according to the guided system versus CXR was also assessed. Results: Guided PICC placements required less repositioning (1.5% vs 10.3%, P =.03) and resulted in more catheters positioned as desired (86.8% vs 67.6%, P =.01) than the external measurement approach. The cost per PICC positioned as desired was lower for guided placements ($318.54 vs $381.44), suggesting that the guided system was cost-effective in this clinical setting. Guided system-CXR agreement for tip position was poor (κ=0.25, P =.002) due to tips being slightly farther from the cavoatrial junction on CXR than indicated by the guided system. Conclusions: The guided PICC placement system was cost-effective in outpatients treated by a single division of interventional radiology at an academic institution.

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