The use of indwelling pleural catheters for the management of malignant pleural effusion--direct costs in a Dutch hospital

Our plain-English summary of The use of indwelling pleural catheters for the management of malignant pleural effusion--direct costs in a Dutch hospital, by R.C. Boshuizen, S. Onderwater, S.J. Burgers, et al (Respiration; International Review of Thoracic Diseases, 2013).

The study

• Authors: R.C. Boshuizen, S. Onderwater, S.J. Burgers, M.M. van den Heuvel
• Journal: Respiration; International Review of Thoracic Diseases
• Published: 2013;86(3):224-8
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Indwelling pleural catheters (IPCs) are increasingly used in the treatment of malignant pleural effusion (MPE). In general, these catheters have been reported to manage MPE efficiently. Unfortunately, insurance companies in the Netherlands do not reimburse these catheters in either first-line treatment or following failed talc pleurodesis.

Objectives: Investigation of direct costs of IPC placement.

Methods: Retrospective analysis of a prospectively collected database. Direct costs for both catheters and vacuum bottles were calculated. Indicators for indirect costs such as adverse events and complications and the need for additional home care for drainage were registered.

Results: Mean costs for IPC amounted to EUR 2,173 and were different between tumor types - mesothelioma: EUR 4,028, breast: EUR 2,204, lung: EUR 1,146 and other: EUR 1,841; p = 0.017. Four patients were admitted to hospital for treatment of complications. Mean costs for IPC placement was similar when inserted as frontline treatment and after failed pleurodesis. Approximately 75% of patients did not need any help from specialized home care.

Conclusion: Direct costs for IPC placement turn out to be acceptable when compared with estimated hospitalization costs for pleurodesis treatment. Randomized controlled trials have to be performed to compare the cost-effectiveness of IPCs compared to pleurodesis.

Copyright © 2013 S. Karger AG, Basel.

In plain English

This study looked at the direct material costs of indwelling pleural catheters. These are tubes left in place so that cancer-related fluid around the lungs (malignant pleural effusion) can be drained at home. The authors analysed a prospectively collected database at the Netherlands Cancer Institute covering 50 catheters in 45 patients, inserted between September 2009 and April 2012. Seven of the catheters were in patients with mesothelioma. Only insertion sets and vacuum bottles or drainage bags were counted. The mean direct cost per catheter was EUR 2,137. Costs differed by tumor type, from EUR 1,146 for lung carcinoma to EUR 4,028 for mesothelioma, but daily costs did not differ significantly by tumor type. Mesothelioma patients had the longest median survival after placement (294 days). Costs did not differ significantly between frontline catheters and catheters placed after an earlier hospital admission for same-side pleurodesis (20 patients, 10 of whom never had talc instilled). About 75% of insertions had no complications, and four patients were hospitalised for complications. The authors concluded that, compared with estimated pleurodesis hospital costs, catheter treatment seemed reasonably priced.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective analysis of a prospectively collected database, single hospital (cost description)
• Who was studied: Patients with symptomatic malignant pleural effusion at the Netherlands Cancer Institute, Amsterdam. Between September 2009 and April 2012, 65 catheters were inserted in 60 patients. After excluding patients followed up elsewhere and non-cancer uses, 50 catheters in 45 patients were analysed. Tumor types (catheters/patients): breast 15/13, lung 8/8, mesothelioma 7/6, gastrointestinal 5/4, urogenital 5/5, ovarian 4/4, other 6/5.
• Exposure: Not an asbestos exposure study. The 'exposure' was treatment with an indwelling pleural catheter. Costs counted were the insertion set (EUR 255), vacuum bottles (EUR 310 per 5 bottles of 600 ml) and peritoneal drainage bags (EUR 195 per 5), all excluding tax.
• Main results:
  • All 50 analysed catheters: mean direct cost per catheter EUR 2,137 (median EUR 1,495, range EUR 379 to 8,315).
  • By tumor type: lowest cost for lung carcinoma (EUR 1,146) and highest for mesothelioma (EUR 4,028).
  • By tumor type: breast cancer and other tumors had costs of EUR 2,204 and EUR 1,841. The difference between tumor types had p = 0.017.
  • Daily costs (total cost divided by drainage duration) did not differ significantly between tumor types: lung EUR 36.9, other EUR 40.5, mesothelioma EUR 45.9, breast EUR 50.7; p = 0.842.
  • The authors compared catheters inserted as first-line (frontline) treatment for malignant pleural effusion with catheters inserted after ipsilateral (same-side) pleurodesis: EUR 1,888 vs 2,512, p = 0.259, not significantly different. The second group was 20 patients who had previously been admitted to hospital for ipsilateral pleurodesis. In 10 of them, no talc was instilled because the lung did not expand enough after drainage.
  • Of the 20 patients previously admitted for ipsilateral pleurodesis, 10 never had talc instilled because of insufficient lung expansion.
  • Catheters used for less than 6 weeks cost less than those used longer: EUR 1,100 vs 2,273; p = 0.002.
  • Patients with mesothelioma had the longest median overall survival from catheter placement to death, 294 days. This compared with breast cancer 58 days, lung cancer 45 days and other tumors 44 days (p = 0.002).
  • 36 of 50 catheters had no complications (about 75%). Four patients were admitted to hospital, for 1, 3, 12 and 14 days, with painful drainage, pneumothorax and empyema (2 admissions).
  • One patient developed a tumor spread along the catheter tract (tract metastasis) 11 months after insertion, which was treated with radiotherapy.
  • No patient needed a further procedure for the effusion after catheter insertion.
  • Drainage was done by home-visiting nurses or during hospital visits for 12 patients (14 catheters, 28%). The rest drained themselves or with family help.
• The authors' conclusion: The authors concluded that costs depended on tumor type and survival time and did not differ between frontline use and use following failed pleurodesis. Compared with estimated costs for pleurodesis, IPC treatment seemed reasonably priced, and complication rates appeared acceptable.
• Limitations the authors state:
  • Indirect costs such as loss of income, travel and home care visits were not included.
  • Patient selection may have been biased by patients' ability to do drainages themselves.
  • Drainage without professional help may differ in other centers.

Topics

Medical terms in this study, explained in our Lexicon: Indwelling Pleural Catheter, Pleural Effusion, Talc Pleurodesis, Mesothelioma, Pleurodesis.

Related studies

• Aggressive versus symptom-guided drainage of malignant pleural effusion via indwelling pleural catheters (AMPLE-2): an open-label randomised trial — S. Muruganandan, M. Azzopardi, et al. (2018)
• Protocol of the Australasian Malignant Pleural Effusion-2 (AMPLE-2) trial: a multicentre randomised study of aggressive versus symptom-guided drainage via indwelling pleural catheters — M. Azzopardi, R. Thomas, et al. (2016)
• Indwelling pleural catheter versus talc pleurodesis for malignant pleural effusion: a meta-analysis — M. Yeung, E.W. Loh, et al. (2020)
• Catheter tract metastasis associated with indwelling pleural catheters — R. Thomas, C.A. Budgeon, et al. (2014)
• Intrapleural Fibrinolysis for the Treatment of Indwelling Pleural Catheter-Related Symptomatic Loculations: A Multicenter Observational Study — R. Thomas, F. Piccolo, et al. (2015)
• Catheter Tract Metastasis in Mesothelioma Patients with Indwelling Pleural Catheters: A Retrospective Cohort Study — M.A. Mitchell, P. Li, et al. (2019)

Browse more research in Respiration; International Review of Thoracic Diseases, or return to medical research.