Economic analysis: PICC versus short catheter for prolonged home antibiotic therapy: PICC versus short catheter for prolonged home antibiotic therapy

Mariana Vélez-Bonilla; Catalina Hernandez Florez; Sandra Brigitte Amado Garzon; Allan Solano-Felizzola; Diego  Andres Rosselli Cock

doi:10.15649/cuidarte.4124

Economic analysis: PICC versus short catheter for prolonged home antibiotic therapy: PICC versus short catheter for prolonged home antibiotic therapy

Título traducido de la contribución: Evaluación económica: PICC versus catéter corto para antibioticoterapia prolongada domiciliaria: PICC versus catéter corto para antibioticoterapia prolongada domiciliaria

Mariana Vélez-Bonilla, Catalina Hernandez Florez, Sandra Brigitte Amado Garzon, Allan Solano-Felizzola, Diego Andres Rosselli Cock

Producción: Contribución a una revista › Artículo › revisión exhaustiva

Resumen

Introducción: Los programas de hospitalización domiciliaria dependen de dispositivos de acceso vascular para administrar antimicrobianos parenterales. Aunque las guías recomiendan catéteres centrales de inserción periférica (PICC) para tratamientos de ≥14 días, se utilizan con frecuencia catéteres periféricos cortos (SPC). Los estudios de costo-efectividad que comparen estos dispositivos y sus complicaciones son limitados. Objetivo: Evaluar económicamente el uso del PICC y el SPC en pacientes con terapia antimicrobiana parenteral ambulatoria. Materiales y Métodos: Se revisaron 1053 artículos sobre complicaciones relacionadas con catéteres, seleccionando 18 tras revisión por pares. Se consultó a expertos y se elaboró una lista de insumos para calcular costos. Se desarrolló un modelo de árbol de decisión con frecuencias de complicaciones y costos, utilizando análisis de costo-efectividad incremental (ICER), sensibilidad univariada (diagrama de tornado) y multivariada (simulación de Monte Carlo). Resultados: Las complicaciones mayores fueron similares entre dispositivos, pero las menores fueron más frecuentes con el SPC. El PICC presentó costos más altos asociados al material y a inserciones realizadas por radiólogos. El análisis multivariado mostró ICER de $49,2 con un 90% de inserciones por enfermeras y de $24,3 con un 100%, asumiendo una reducción del 50% en el precio del PICC. Discusión: Los PICC parecen más efectivos en la prevención de complicaciones menores. Las inserciones por enfermería y la reducción del costo del material del catéter podrían disminuir significativamente los costos totales. Conclusiones: Incrementar el uso del PICC para tratamientos prolongados podría reducir costos y mejorar la costo-efectividad, siendo más económico pese a costos iniciales más altos.

Título traducido de la contribución	Evaluación económica: PICC versus catéter corto para antibioticoterapia prolongada domiciliaria: PICC versus catéter corto para antibioticoterapia prolongada domiciliaria
Idioma original	Inglés
Número de artículo	4124
Páginas (desde-hasta)	1-13
Número de páginas	13
Publicación	Revista Cuidarte
Volumen	16
N.º	2
DOI	https://doi.org/10.15649/cuidarte.4124
Estado	Publicada - 01 may. 2025

Palabras clave

Hospital at Home; Catheterization Peripheral; Catheters; CatheterRelated Infections; Deep Vein Thrombosis

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@article{f970200169d14483903bc1beba2b8da4,

title = "Economic analysis: PICC versus short catheter for prolonged home antibiotic therapy: PICC versus short catheter for prolonged home antibiotic therapy",

abstract = "INTRODUCTION: Hospital-at-home programs rely on vascular access devices for secure administration of parenteral antimicrobials. While guidelines recommend peripherally inserted central catheters (PICC) for treatments ≥14 days, short peripheral catheters (SPC) are often used instead. Cost-effectiveness studies comparing these devices and their complications are limited.OBJECTIVE: This study conducted an economic evaluation comparing PICC and SPC for patient outpatient parenteral antibiotic therapy.MATERIALS AND METHODS: A literature review of catheter complication frequencies yielded 1053 papers, narrowed to 18 after independent peer review. Experts were consulted, and a list of items required for catheter use was compiled to determine costs. A decision tree model was developed based on complication frequencies and costs. Results were analyzed using incremental cost-effectiveness ratios (ICER), univariate sensitivity analysis (tornado diagram), and multivariate sensitivity analysis (Monte Carlo simulation).RESULTS: Major complications were similar between devices, but minor complications were more frequent with SPC. The PICC reference case assumed 50\%-50\% radiologist/nurse insertion, catheter cost (\$74,7), ≤15-day treatment, and complication prevalence. Higher costs associated with PICC were linked to catheter material and radiologist insertion. Multivariate analysis showed ICERs of \$49,2 with 90\% nurse-led insertion and \$24,3 with 100\% nurse-led insertions, assuming a 50\% PICC price reduction.DISCUSSION: PICC was more effective in reducing minor complications. Costs decreased with nurse-led insertions and lower catheter material costs.CONCLUSION: Increasing PICC use for extended treatments could reduce overall costs and lower ICERs, highlighting their potential economic advantage despite higher initial expenses.",

keywords = "Hospital at Home; Catheterization Peripheral; Catheters; CatheterRelated Infections; Deep Vein Thrombosis, Catheter-Related Infections, Catheterization Peripheral, Catheters, Deep Vein Thrombosis, Outpatients",

author = "Mariana V{\'e}lez-Bonilla and \{Hernandez Florez\}, Catalina and \{Amado Garzon\}, \{Sandra Brigitte\} and Allan Solano-Felizzola and \{Rosselli Cock\}, \{Diego Andres\}",

year = "2025",

month = may,

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doi = "10.15649/cuidarte.4124",

language = "English",

volume = "16",

pages = "1--13",

journal = "Revista Cuidarte",

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publisher = "Universidad de Santander",

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Economic analysis: PICC versus short catheter for prolonged home antibiotic therapy: PICC versus short catheter for prolonged home antibiotic therapy. / Vélez-Bonilla, Mariana; Hernandez Florez, Catalina ; Amado Garzon, Sandra Brigitte et al.
En: Revista Cuidarte, Vol. 16, N.º 2, 4124, 01.05.2025, p. 1-13.

Producción: Contribución a una revista › Artículo › revisión exhaustiva

TY - JOUR

T1 - Economic analysis: PICC versus short catheter for prolonged home antibiotic therapy

T2 - PICC versus short catheter for prolonged home antibiotic therapy

AU - Vélez-Bonilla, Mariana

AU - Hernandez Florez, Catalina

AU - Amado Garzon, Sandra Brigitte

AU - Solano-Felizzola, Allan

AU - Rosselli Cock, Diego Andres

PY - 2025/5/1

Y1 - 2025/5/1

N2 - INTRODUCTION: Hospital-at-home programs rely on vascular access devices for secure administration of parenteral antimicrobials. While guidelines recommend peripherally inserted central catheters (PICC) for treatments ≥14 days, short peripheral catheters (SPC) are often used instead. Cost-effectiveness studies comparing these devices and their complications are limited.OBJECTIVE: This study conducted an economic evaluation comparing PICC and SPC for patient outpatient parenteral antibiotic therapy.MATERIALS AND METHODS: A literature review of catheter complication frequencies yielded 1053 papers, narrowed to 18 after independent peer review. Experts were consulted, and a list of items required for catheter use was compiled to determine costs. A decision tree model was developed based on complication frequencies and costs. Results were analyzed using incremental cost-effectiveness ratios (ICER), univariate sensitivity analysis (tornado diagram), and multivariate sensitivity analysis (Monte Carlo simulation).RESULTS: Major complications were similar between devices, but minor complications were more frequent with SPC. The PICC reference case assumed 50%-50% radiologist/nurse insertion, catheter cost ($74,7), ≤15-day treatment, and complication prevalence. Higher costs associated with PICC were linked to catheter material and radiologist insertion. Multivariate analysis showed ICERs of $49,2 with 90% nurse-led insertion and $24,3 with 100% nurse-led insertions, assuming a 50% PICC price reduction.DISCUSSION: PICC was more effective in reducing minor complications. Costs decreased with nurse-led insertions and lower catheter material costs.CONCLUSION: Increasing PICC use for extended treatments could reduce overall costs and lower ICERs, highlighting their potential economic advantage despite higher initial expenses.

AB - INTRODUCTION: Hospital-at-home programs rely on vascular access devices for secure administration of parenteral antimicrobials. While guidelines recommend peripherally inserted central catheters (PICC) for treatments ≥14 days, short peripheral catheters (SPC) are often used instead. Cost-effectiveness studies comparing these devices and their complications are limited.OBJECTIVE: This study conducted an economic evaluation comparing PICC and SPC for patient outpatient parenteral antibiotic therapy.MATERIALS AND METHODS: A literature review of catheter complication frequencies yielded 1053 papers, narrowed to 18 after independent peer review. Experts were consulted, and a list of items required for catheter use was compiled to determine costs. A decision tree model was developed based on complication frequencies and costs. Results were analyzed using incremental cost-effectiveness ratios (ICER), univariate sensitivity analysis (tornado diagram), and multivariate sensitivity analysis (Monte Carlo simulation).RESULTS: Major complications were similar between devices, but minor complications were more frequent with SPC. The PICC reference case assumed 50%-50% radiologist/nurse insertion, catheter cost ($74,7), ≤15-day treatment, and complication prevalence. Higher costs associated with PICC were linked to catheter material and radiologist insertion. Multivariate analysis showed ICERs of $49,2 with 90% nurse-led insertion and $24,3 with 100% nurse-led insertions, assuming a 50% PICC price reduction.DISCUSSION: PICC was more effective in reducing minor complications. Costs decreased with nurse-led insertions and lower catheter material costs.CONCLUSION: Increasing PICC use for extended treatments could reduce overall costs and lower ICERs, highlighting their potential economic advantage despite higher initial expenses.

KW - Hospital at Home; Catheterization Peripheral; Catheters; CatheterRelated Infections; Deep Vein Thrombosis

KW - Catheter-Related Infections

KW - Catheterization Peripheral

KW - Catheters

KW - Deep Vein Thrombosis

KW - Outpatients

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DO - 10.15649/cuidarte.4124

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Economic analysis: PICC versus short catheter for prolonged home antibiotic therapy: PICC versus short catheter for prolonged home antibiotic therapy

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