Cost-effectiveness-analysis of ultrasound guidance for central venous catheterization compared with landmark method: a decision-analytic model.
Central venous catheterization
Cost-effectiveness
Modelling
Ultrasound guidance
Journal
BMC anesthesiology
ISSN: 1471-2253
Titre abrégé: BMC Anesthesiol
Pays: England
ID NLM: 100968535
Informations de publication
Date de publication:
09 04 2019
09 04 2019
Historique:
received:
09
10
2018
accepted:
24
03
2019
entrez:
11
4
2019
pubmed:
11
4
2019
medline:
23
2
2020
Statut:
epublish
Résumé
Ultrasound guidance for central venous catheterization is a commonly used alternative to the conventional landmark method. Because from the German perspective, the cost-effectiveness of ultrasound guidance is unclear, this study examined the cost-effectiveness of ultrasound guidance versus the landmark method for adults undergoing a central venous catheterization. A decision-tree based model was built to estimate the costs of averted catheter-related complications. Clinical data (e.g. arterial puncture, failed attempts) were obtained from a Cochrane review and a randomized controlled trial, whilst information about cost parameters were taken from a German hospital of maximum care. The analysis was conducted from the perspective of the German Statutory Health Insurance. Results were presented as incremental cost-effectiveness ratios. To assess the parameter uncertainty, several sensitivity analyses were performed (deterministic, probabilistic and with regard to the model structure). Our analysis revealed that ultrasound guidance resulted in fewer complications per person (0.04 versus 0.17 for the landmark method) and was less expensive (€51 versus €230 for the landmark method). Results were robust to changes in the model parameters and in the model structure. Whilst our model population reflected approximately 49% of adults undergoing a central venous catheterization cannulation per year, structural sensitivity analyses (e.g. extending the study cohort to patients at higher baseline risk of complications, pediatric patients, or using real-time/indirect catheterization) indicated the cost-effectiveness of ultrasound guidance for a broader spectrum of patients. The results should be interpreted by considering the assumptions (e.g. target population) and approximations (e.g. cost parameters) underpinning the model. Ultrasound guidance for central venous catheterization averts more catheter-related complications and may save the resources of the German Statutory Health Insurance compared with landmark method.
Sections du résumé
BACKGROUND
Ultrasound guidance for central venous catheterization is a commonly used alternative to the conventional landmark method. Because from the German perspective, the cost-effectiveness of ultrasound guidance is unclear, this study examined the cost-effectiveness of ultrasound guidance versus the landmark method for adults undergoing a central venous catheterization.
METHODS
A decision-tree based model was built to estimate the costs of averted catheter-related complications. Clinical data (e.g. arterial puncture, failed attempts) were obtained from a Cochrane review and a randomized controlled trial, whilst information about cost parameters were taken from a German hospital of maximum care. The analysis was conducted from the perspective of the German Statutory Health Insurance. Results were presented as incremental cost-effectiveness ratios. To assess the parameter uncertainty, several sensitivity analyses were performed (deterministic, probabilistic and with regard to the model structure).
RESULTS
Our analysis revealed that ultrasound guidance resulted in fewer complications per person (0.04 versus 0.17 for the landmark method) and was less expensive (€51 versus €230 for the landmark method). Results were robust to changes in the model parameters and in the model structure. Whilst our model population reflected approximately 49% of adults undergoing a central venous catheterization cannulation per year, structural sensitivity analyses (e.g. extending the study cohort to patients at higher baseline risk of complications, pediatric patients, or using real-time/indirect catheterization) indicated the cost-effectiveness of ultrasound guidance for a broader spectrum of patients. The results should be interpreted by considering the assumptions (e.g. target population) and approximations (e.g. cost parameters) underpinning the model.
CONCLUSIONS
Ultrasound guidance for central venous catheterization averts more catheter-related complications and may save the resources of the German Statutory Health Insurance compared with landmark method.
Identifiants
pubmed: 30967124
doi: 10.1186/s12871-019-0719-5
pii: 10.1186/s12871-019-0719-5
pmc: PMC6456944
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
51Références
Cochrane Database Syst Rev. 2015 Jan 09;1:CD006962
pubmed: 25575244
Lancet. 2005 Jan 1-7;365(9453):82-93
pubmed: 15639683
Anaesthesia. 2016 May;71(5):573-85
pubmed: 26888253
Br J Anaesth. 2010 Aug;105(2):179-84
pubmed: 20542889
Value Health. 2012 Sep-Oct;15(6):843-50
pubmed: 22999134
Indian J Crit Care Med. 2009 Oct;13(4):213-6
pubmed: 20436690
Clinics (Sao Paulo). 2009;64(10):989-92
pubmed: 19841706
Dtsch Med Wochenschr. 2000 Jul 14;125(28-29):852-6
pubmed: 10943214
Anaesthesia. 2004 Nov;59(11):1116-20
pubmed: 15479322
BMJ. 2003 Aug 16;327(7411):361
pubmed: 12919984
Can J Anaesth. 2010 May;57(5):500-14
pubmed: 20373154
JAMA. 2001 Aug 8;286(6):700-7
pubmed: 11495620
Chest. 1990 Jul;98(1):157-60
pubmed: 2193776
Crit Care. 2006;10(6):R162
pubmed: 17112371
Anaesthesist. 1989 Nov;38(11):633-8
pubmed: 2699786
Rev Bras Ter Intensiva. 2016 Jan-Mar;28(1):62-9
pubmed: 27096678
Anaesthesist. 2009 Jul;58(7):677-85
pubmed: 19547936
Ger Med Sci. 2009 Nov 18;7:Doc19
pubmed: 20049083
Crit Care. 2018 Mar 13;22(1):65
pubmed: 29534732
Br J Anaesth. 1993 Feb;70(2):145-8
pubmed: 8435256
Value Health. 2007 Sep-Oct;10(5):326-35
pubmed: 17888097
J Am Coll Surg. 2013 May;216(5):939-43
pubmed: 23478546
Indian J Radiol Imaging. 2009 Jul-Sep;19(3):191-8
pubmed: 19881083
Anesthesiology. 1996 Jul;85(1):43-8
pubmed: 8694381
Anesthesiology. 2013 Feb;118(2):361-75
pubmed: 23249991
Value Health. 2009 Jun;12(4):409-18
pubmed: 19900249
Value Health. 2014 Jan-Feb;17(1):5-14
pubmed: 24438712
BMJ. 2013 Mar 25;346:f1049
pubmed: 23529982