Treatment of malignant pleural effusion: PleuRx catheter or talc pleurodesis? A cost-effectiveness analysis.
BACKGROUND
Malignant pleural effusions (MPEs) complicate many advanced malignancies and the median prognosis for those who develop MPEs is 6 months. These effusions lead patients to suffer from significant dyspnea, which may consequently impair mobility and lead to reduced quality of life. There are several treatment options for those with MPE. Thoracentesis may be quick and relatively easy to perform, but has a high recurrence rate; chest tube placement with talc slurry is quite effective at achieving pleurodesis, but this procedure can be quite painful and requires hospitalization. An alternative option is outpatient placement of the Pleurx catheter (Denver Biomedical Inc., Denver, CO) for home-based drainage of effusions.


OBJECTIVE
To determine the incremental cost effectiveness of treating MPE with talc pleurodesis versus placement of Pleurx catheter.


METHODS
We used decision analysis to compare treatments for the management of MPE. Cost data for Pleurx and talc treatments were obtained using Medicare reimbursement data for 2008, and outcome data (probability of treatment success and/or complication, and utility of health states) were obtained through literature review.


RESULTS
Under our base-case analysis, treatment with talc was less costly than Pleurx (talc, $8170.80; Pleurx, $9011.60) with similar effectiveness (talc, 0.281 quality adjusted life years [QALYs]; Pleurx, 0.276 QALYs). Pleurx became more cost effective (<$100K/QALY) when life expectancy was 6 weeks or less.


CONCLUSIONS
The treatment choice (talc pleurodesis or Pleurx catheter) for those with an MPE and a prognosis of 6 months should be based on the clinical situation and patient preferences, as well as local expertise and success rates of the procedures. A prospective study specific to the palliative care population might help to clarify which treatment is more cost effective in this population in which optimizing quality of life is essential.
Division of Ethics, Humanities, and Palliative Care, University of Rochester, Rochester, New York 14642, USA. aaron_olden@urmc.rochester.edu
Aaron M
AM
Olden
Robert
R
Holloway
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D016017:Odds Ratio; D016066:Pleural Effusion, Malignant / Q000188:drug therapy*; D018700:Pleurodesis / Q000191:economics*; D012189:Retrospective Studies; D015996:Survival Rate; D013627:Talc / Q000008:administration & dosage*; D016896:Treatment Outcome; D055815:Young Adult
D013627:Talc