Cost effectiveness of different central venous approaches for port placement and use in adult oncology patients: evidence from a randomized three-arm trial.
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.


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 <euro>2,167.85 for subclavian US-guided, <euro>2,335.87 for cephalic, and <euro>2,384.10 for internal jugular access, respectively (p = 0.0001).


CONCLUSIONS
US real-time guidance to the subclavian vein resulted in the most cost-effective method of central venous port placement and use.
Division of Abdomino-Pelvic and Minimally Invasive Surgery, European Institute of Oncology, Milan, Italy, roberto.biffi@ieo.it.
Roberto
R
Biffi
Simonetta
S
Pozzi
Guido
G
Bonomo
Paolo
P
Della Vigna
Lorenzo
L
Monfardini
Davide
D
Radice
Nicole
N
Rotmensz
Maria Giulia
MG
Zampino
Nicola
N
Fazio
Franco
F
Orsi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000191:economics*; D002408:Catheters, Indwelling / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015918:Infusion Pumps, Implantable / Q000191:economics*; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics* / Q000473:pathology; D011379:Prognosis; D055815:Young Adult
D000970:Antineoplastic Agents