Clinical studyCost-effectiveness Analysis of Implantable Venous Access Device Insertion Using Interventional Radiologic versus Conventional Operating Room Methods 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.