Complications Associated With Use of Long-Term Central Venous Catheters Among Commercially Insured Women With Breast Cancer.
OBJECTIVE
Despite some advantages to their use, long-term central venous catheters (CVCs) are associated with complications for patients who require chemotherapy. Understanding of these risks in commercially insured populations is limited. This information can inform medical policies that ensure the appropriate use of venous access devices. This study's objectives were to assess the extent of variation in use of long-term CVCs in a cohort of commercially insured women with breast cancer, and to assess risks of associated complications.


METHODS
Retrospective cohort analysis was conducted using health insurance claims between January 2006 and October 2013. The cohort included commercially insured women age ≥ 18 years diagnosed with breast cancer who received infusion chemotherapy (N = 31,047). We conducted matched and case-mix adjusted Cox proportional hazard modeling to assess differences in bloodstream infections and thrombovascular complications between patients using long-term CVCs and those using temporary intravenous catheters.


RESULTS
Approximately two thirds of the cohort had a long-term CVC, although rates varied across regions (57% to 75%), health plans (65% to 70%), and insurance coverage (63% to 68%). After propensity score matching, the adjusted hazard ratio for infection was 2.70 (95% CI, 2.31 to 3.16) and thrombovascular complications, 2.61 (95% CI, 2.33 to 2.93) in patients with long-term CVCs compared with those with temporary intravenous catheters.


CONCLUSIONS
Although long-term CVCs may have benefits, they are associated with increased morbidity. Regional and health plan variation in long-term CVC insertion suggests that some of their use reflects provider- or institution-driven variation in practice. Evidence-based guidelines and tools may help decrease discretionary use of long-term CVCs.
Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN snyderma@mskcc.org.
Allison
A
Lipitz-Snyderman
Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN.
Qinli
Q
Ma
Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN.
Michael F
MF
Pollack
Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN.
John
J
Barron
Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN.
Elena B
EB
Elkin
Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN.
Peter B
PB
Bach
Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY; HealthCore, Wilmington DE; and Anthem, Indianapolis, IN.
Jennifer L
JL
Malin
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000188:drug therapy*; D055499:Catheter-Related Infections / Q000209:etiology; D062905:Central Venous Catheters / Q000009:adverse effects*; D004617:Embolism / Q000209:etiology; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007348:Insurance, Health; D008875:Middle Aged; D013923:Thromboembolism / Q000209:etiology; D013927:Thrombosis / Q000209:etiology; D055815:Young Adult