Cost-effectiveness Analysis of Implantable Venous Access Device Insertion Using Interventional Radiologic versus Conventional Operating Room Methods in Pediatric Patients with Cancer

doi:10.1016/j.jvir.2010.01.014

Journal of Vascular and Interventional Radiology

Volume 21, Issue 5, May 2010, Pages 677-684

https://doi.org/10.1016/j.jvir.2010.01.014 Get rights and content

Purpose

Percutaneous image-guided techniques are associated with less tissue trauma and morbidity than open surgical techniques. Interventional radiology has received significant health care investment. The purpose was to determine the cost effectiveness of inserting implantable venous access devices (IVADs) by interventional radiologic means versus conventional operating room surgery in pediatric patients with cancer.

Materials and Methods

In a retrospective cohort analysis, patients presenting with a new tumor diagnosis and receiving a first-time IVAD in January to June 2000 (operative group; n = 30) and January to June 2004 (interventional group; n = 30) were included. A societal costing perspective was adopted. Costs included labor, materials, equipment, inpatient wards, parent travel, and parental productivity losses for 30 days after insertion. Severe complications related to IVAD insertion were microcosted. Costs related to cancer therapy were not included. Incremental cost-effectiveness analysis and sensitivity analysis were performed.

Results

Interventional patients were older (7.3 years vs 4.1 years; P = .01). There were no significant differences between groups in sex, American Society of Anesthesiologists score, or length of hospital stay. Interventional radiologic procedures were shorter (84.9 minutes vs 112.8 minutes; P = 0.01). Interventional radiologic insertion was slightly less costly than operative insertion (Can$622,860 and Can$627,005 per 30-patient group, respectively) and more effective in reducing the complication rate (two vs eight complications per group, respectively; P = .039). The results were sensitive to the cost of operating the operating room.

Conclusions

Interventional radiology was slightly less costly than operative IVAD insertion and resulted in fewer serious complications. It should be considered for IVAD insertions in pediatric patients with cancer.

Section snippets

Study Design

This retrospective cohort study used data from medical charts and clinical databases of patients at HSC. Ethics approval was obtained from the HSC Research Ethics Board.

Given that most IVAD insertions were performed with interventional radiologic means at the time of the study, the use of parallel study groups was not possible. Therefore, pediatric patients of all ages with cancer who had an IVAD inserted in the interventional radiology suites from January to June 2004 or in the operating room

Results

The data were examined for normality by way of skewness and kurtosis measures and were found to be normally distributed. Patient characteristics are summarized in Table 1. The mean age of patients in the interventional group was significantly higher than in the operative group, by approximately 3 years. There was no significant difference between groups in sex or mean ASA score. The most common diagnosis in both groups was acute lymphocytic leukemia. Only one patient in the interventional group

Discussion

IVAD insertion in pediatric patients with cancer by interventional radiologic means was slightly less costly and resulted in fewer complications in the 30 days after insertion compared with IVAD insertion via surgical techniques. The mean length of hospital stay did not differ between groups, suggesting that the intervention did not affect recovery time. The sensitivity analysis found that the results were sensitive to operating room costs. This was expected given the small difference in cost

Acknowledgments

The authors acknowledge the following individuals who made significant technical contributions toward this study: Peter Chait, Ziv Shnitzer, Linda Whyte, Beverley Conquest, Doina Filipescu, Jennifer Vaughan, Susan Stansfield, Leonardo Brandao, and Hana Zita.

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: R.H.H. received doctoral scholarship support from the Organization for Teratology Information Services and the University of Toronto Institute for Medical Sciences and was the recipient of a Banting and Best Doctoral Award from the Canadian Institutes for Health Research. W.J.U. was supported by a Canadian Institutes for Health Research New Investigator award. In-kind support was received from The Hospital for Sick Children Research Institute. None of the authors have identified a conflict of interest.

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Clinical studyCost-effectiveness Analysis of Implantable Venous Access Device Insertion Using Interventional Radiologic versus Conventional Operating Room Methods in Pediatric Patients with Cancer

Purpose

Materials and Methods

Results

Conclusions

Section snippets

Study Design

Results

Discussion

Acknowledgments

J Pediatr Surg

J Pediatr Surg

J Vasc Interv Radiol

Ann Oncol

Best Pract Res Clin Anaesthesiol

Eur J Cancer

J Vasc Interv Radiol

Unique centre for image-guided therapy opens at Sick Kids [press release]

Annual Report 1999–2000: The Hospital for Sick Children Journal

Radiological placement of subcutaneous infusion chest ports for long-term central venous access

AJR Am J Roentgenol

A comparative analysis of radiological and surgical placement of central venous catheters

Cardiovasc Intervent Radiol

Tunneled central venous access catheter placement in the pediatric population: comparison of radiologic and surgical results

Radiology

Totally implantable central venous access devices for paediatric oncology patients

Med Pediatr Oncol

Clinical study
Cost-effectiveness Analysis of Implantable Venous Access Device Insertion Using Interventional Radiologic versus Conventional Operating Room Methods in Pediatric Patients with Cancer