title: Cost-effectiveness analysis of ultrasound-guided Seldinger peripherally inserted central catheters (PICC).
abstract: BACKGROUND
  Ultrasound-guided cannulation of deep mid-arm veins by a modified Seldinger (US-Seldinger) technique has been demonstrated to yield better puncture success rates and lower postoperative complication rates than direct cannulation of superficial veins near the elbow with a short peripheral cannula and peripherally inserted central catheter (PICC) insertion through the cannula (non-US conventional method). Economic factors have been evaluated across different operators (i.e. nurses, radiologists, and general practitioners) and different venous catheter types (i.e. PICCs vs. central venous catheters). However, to our knowledge, data describing the economic evaluation on the aforementioned modified Seldinger technique are lacking. Hence, the aim of this study was to evaluate the cost-effectiveness of US-Seldinger technique (experimental group) compared with that of the non-US conventional method based on direct vein visualization (control group).
  
  
  RESULTS
  A cohort of 360 subjects were assigned randomly to the experimental and control groups. Cost-effectiveness ratio (CER) analyses indicated that the effectiveness index (EI) for the experimental group was 89.29% (final CER = 3732.75), whereas that for the control group was 59.18% (final CER = 2492.98).
  
  
  CONCLUSIONS
  The US-Seldinger technique was found to be more cost-effective than the non-US conventional method. These findings support the use of the former in place of the traditional latter technique as a routine puncture technique and suggest that the update would improve intravenous therapy treatment for patients needing PICCs. This study should serve as a reference for national healthcare policy.Trial registrationChiCTR-TRC-14004993.
authors.affiliation: Nursing College of Central South University, Zhuzhou Central Hospital, Room 210, Administration Building, Zhuzhou, 410007 Hunan China ; Zhuzhou Central Hospital, Zhuzhou, 410007 Hunan China.
authors.forename: Jianghong
authors.initials: J
authors.lastname: Tan
authors.affiliation: Zhuzhou Central Hospital, Zhuzhou, 410007 Hunan China.
authors.forename: Liping
authors.initials: L
authors.lastname: Liu
authors.affiliation: Zhuzhou Central Hospital, Zhuzhou, 410007 Hunan China.
authors.forename: Jing
authors.initials: J
authors.lastname: Xie
authors.affiliation: Zhuzhou Central Hospital, Zhuzhou, 410007 Hunan China.
authors.forename: Lingli
authors.initials: L
authors.lastname: Hu
authors.affiliation: Nursing College of Central South University, Yuelu District Tongzipo Road, Changsha, 410013 Hunan China.
authors.forename: Qiaolan
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Nursing College of Central South University, Zhuzhou Central Hospital, Room 210, Administration Building, Zhuzhou, 410007 Hunan China ; Nursing College of Central South University, Yuelu District Tongzipo Road, Changsha, 410013 Hunan China.
authors.forename: Honghong
authors.initials: H
authors.lastname: Wang
keywords: Cost-effectiveness; Peripherally inserted central catheter; Seldinger technology; Ultrasound