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Cost Effectiveness of Different Central Venous Approaches for Port Placement and Use in Adult Oncology Patients: Evidence From a Randomized Three-Arm Trial

  • Healthcare Policy and Outcomes
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Abstract

Background

No randomized trials have so far investigated the cost effectiveness of different methods for implantation and use of central venous ports in oncology patients.

Patients and Methods

Overall, 403 patients eligible for receiving intravenous chemotherapy for solid tumours were randomly assigned to implantation of a single type of port, either through a percutaneous landmark access to the internal jugular vein, an ultrasound (US)-guided access to the subclavian vein, or a surgical cut-down access through the cephalic vein at the deltoid-pectoralis groove. Insertion and maintenance costs were estimated by obtaining the charges for an average implant and use, while the costs of the management of complications were analytically assessed. The total cost was defined as the purchase cost plus the insertion cost plus the maintenance cost plus the cost of treatment of the complications, if any.

Results

A total of 401 patients were evaluable—132 with the internal jugular vein, 136 with the subclavian vein and 133 with the cephalic vein access. No differences were found for the rate of early complications. The US-guided subclavian insertion site had significantly lower failures. Infections occurred in 1, 3, and 3 patients (internal jugular, subclavian, and cephalic access, respectively; p = 0.464), whereas venous thrombosis was observed in 15, 8, and 11 patients, respectively (p = 0.272). Mean cost for purchase, implantation, diagnosis and treatment of complications in each patient was €2,167.85 for subclavian US-guided, €2,335.87 for cephalic, and €2,384.10 for internal jugular access, respectively (p = 0.0001).

Conclusion

US real-time guidance to the subclavian vein resulted in the most cost-effective method of central venous port placement and use.

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Acknowledgment

This study has been supported by a biennial research grant from AIRC—Associazione Italiana per la Ricerca sul Cancro (Italian Association for Cancer Research), Grant Application Number 1126. Bard Italia, Rome, offered technical support for this study.

Conflict of interest

None.

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Authors and Affiliations

  1. Division of Abdomino-Pelvic and Minimally Invasive Surgery, European Institute of Oncology, Milan, Italy

    Roberto Biffi MD & Simonetta Pozzi MD

  2. Interventional Radiology Unit, European Institute of Oncology, Milan, Italy

    Guido Bonomo MD, Paolo Della Vigna MD, Lorenzo Monfardini MD & Franco Orsi MD

  3. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy

    Davide Radice MSc & Nicole Rotmensz MSc

  4. Department of Medicine, European Institute of Oncology, Milan, Italy

    Maria Giulia Zampino MD & Nicola Fazio MD

Authors
  1. Roberto Biffi MD
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  2. Simonetta Pozzi MD
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  3. Guido Bonomo MD
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  4. Paolo Della Vigna MD
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  5. Lorenzo Monfardini MD
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  6. Davide Radice MSc
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  7. Nicole Rotmensz MSc
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  8. Maria Giulia Zampino MD
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  9. Nicola Fazio MD
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  10. Franco Orsi MD
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Corresponding author

Correspondence to Roberto Biffi MD.

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Biffi, R., Pozzi, S., Bonomo, G. et al. Cost Effectiveness of Different Central Venous Approaches for Port Placement and Use in Adult Oncology Patients: Evidence From a Randomized Three-Arm Trial. Ann Surg Oncol 21, 3725–3731 (2014). https://doi.org/10.1245/s10434-014-3784-5

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  • DOI: https://doi.org/10.1245/s10434-014-3784-5

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