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Siefen AC, Eilers L, Baltin CT, Kron F. Cost Comparison of Treatment Alternatives for Pleural Effusion and Ascites from a Payer Perspective: Are There Cost Savings from Indwelling Catheters? J Palliat Med 2023; 26:1510-1520. [PMID: 37352428 PMCID: PMC10658739 DOI: 10.1089/jpm.2022.0592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/25/2023] Open
Abstract
Background: The presence of pleural effusions and ascites in patients is often considered a marker of illness severity and a poor prognostic indicator. This study aims to compare inpatient and outpatient costs of alternative invasive treatments for ascites and pleural effusions. Methods: The retrospective single-institution study included inpatient cases treated for pleural effusion (J90 and J91) or ascites (R18) at the University Hospital Cologne (UHC) in Germany between January 01, 2020, and December 31, 2021. Costs for punctures and indwelling catheter systems (ICSs) as well as pleurodesis were analyzed in different comparator treatment pathways. Real-world data from the UHC tertiary care center were based on diagnosis-related group fees from 2020 to 2021. A simulation of outpatient expenses was carried out to compare inpatient and outpatient costs for each pathway from a payer perspective. Results: A total of 4323 cases (3396 pleural effusions and 1302 ascites) were analyzed. For ascites, inpatient implantation with home care drainage was found to be the most expensive option, with total costs of €1,918.58 per procedure, whereas outpatient puncture was the least expensive option at €60.02. For pleural effusions, the most expensive treatment pathway was pleurodesis at €8,867.84 compared with the least costly option of outpatient puncture resulting in total costs per procedure of €70.03. A break-even analysis showed that outpatient puncture remains the most inexpensive treatment option, and the ICS comprises a cost-saving potential. Longevity of several months with the use of ICSs results in both enhanced quality of life for patients and increased cost savings.
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Affiliation(s)
| | - Leonie Eilers
- VITIS Healthcare Group, Cologne, Germany
- KCM KompetenzCentrum für Medizinoekonomie, FOM University of Applied Sciences, Essen, Germany
| | - Christoph T. Baltin
- VITIS Healthcare Group, Cologne, Germany
- KCM KompetenzCentrum für Medizinoekonomie, FOM University of Applied Sciences, Essen, Germany
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Florian Kron
- VITIS Healthcare Group, Cologne, Germany
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Centre for Integrated Oncology (CIO ABCD), University of Cologne, Cologne, Germany
- KCM KompetenzCentrum für Medizinoekonomie, FOM University of Applied Sciences, Essen, Germany
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Yeung M, Loh EW, Tiong TY, Tam KW. Indwelling pleural catheter versus talc pleurodesis for malignant pleural effusion: a meta-analysis. Clin Exp Metastasis 2020; 37:541-549. [PMID: 32524317 DOI: 10.1007/s10585-020-10042-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023]
Abstract
Malignant pleural effusion (MPE) results from primary mesothelioma or the spreading of metastatic cancer. Both talc pleurodesis (TP) and indwelling pleural catheter (IPC) improve MPE symptoms. We performed a meta-analysis of randomized controlled trials to compare the efficacy of TP with that of IPC in patients with MPE. PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov databases were searched for studies published before February 2020. Individual effect sizes were standardized, and a meta-analysis was conducted to calculate a pooled effect size by using random effects models. In total, 4 trials with 500 patients were reviewed. Difference in pleurodesis success rate and change in dyspnea scores at 4 and 6 weeks between MPE patients treated with IPC and those treated with TP for pleurodesis were nonsignificant. The number of hospital inpatient days was significantly lower among patients who were treated with IPC (weight mean difference: 2.19; 95% confidence interval 0.70-3.67) than among those who were treated with TP. No significant difference was shown in adverse event profile between patients treated with IPC and those treated with TP for pleurodesis. In conclusion, both TP and IPC are equally effective in treating patients with MPE. The number of hospitalization days was significantly lower for patients who were treated with IPC, but the magnitude of the difference is of uncertain clinical importance.
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Affiliation(s)
- Maggie Yeung
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - El-Wui Loh
- Centre for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tung-Yu Tiong
- Division of Thoracic Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Ka-Wai Tam
- Centre for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan. .,Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan. .,Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. .,Cochrane Taiwan, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Wang L, Deng H, Chen X, Li C, Yi F, Wei Y, Zhang W. Talc pleurodesis versus indwelling pleural catheter among patients with malignant pleural effusion: a meta-analysis of randomized controlled trials. World J Surg Oncol 2020; 18:184. [PMID: 32703255 PMCID: PMC7379784 DOI: 10.1186/s12957-020-01940-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Talc pleurodesis (TP) and indwelling pleural catheter (IPC) are used for the management of malignant pleural effusion (MPE). Our meta-analysis was conducted to assess the efficacy and safety of both treatments among patients with MPE. METHODS We acquired pertinent randomized controlled trials (RCTs) by searching PubMed, ScienceDirect, the Cochrane Library, Scopus, Ovid Medline, Embase, Web of Science, and Google Scholar. The endpoints included survival, pleurodesis rates, total drainage, further pleural interventions, hospital days, symptoms, quality of life (QoL), and complications. RESULTS We included four high-quality RCTs. Both treatments were effective among patients with MPE and no previous pleurodesis, with comparable survival and equivalent relief of breathlessness. Additionally, the TP group had higher pleurodesis rates, less total drainage, and fewer all-grade complications (including catheter blockage and cellulitis). However, patients in the TP group had more pleural procedures and relatively longer hospital stays. Additionally, no apparent difference was detected in QoL. CONCLUSIONS TP has better pleurodesis rates, less total drainage, and fewer all-grade complications. However, TP has more pleural procedures and is not feasible for patients with trapped lungs. IPC has fewer further pleural interventions and shorter hospital stays. However, IPC has the nuisance of long-term in situ draining.
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Affiliation(s)
- Li Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Rd, Nanchang, 330006, People's Republic of China
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Huan Deng
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Rd, Nanchang, 330006, People's Republic of China
| | - Xinling Chen
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Can Li
- Department of Respiratory and Critical Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
- Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Fengming Yi
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Yiping Wei
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Rd, Nanchang, 330006, People's Republic of China.
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, No. 1, Minde Rd, Nanchang, 330006, People's Republic of China.
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Foote DC, Burke CR, Pandian B, Banks S, Haug KL, Hipp M, Zhao L, Smola B, Roh M, Carrott PW, Lynch WR, Chang AC, Lin J, Reddy RM. Gender Disparity in Referral for Definitive Care of Malignant Pleural Effusions. J Surg Res 2019; 244:409-416. [DOI: 10.1016/j.jss.2019.06.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 05/23/2019] [Accepted: 06/14/2019] [Indexed: 01/13/2023]
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Yang TS, Hsia DW, Chang DW. Patient- and Hospital-Level Factors Associated With Readmission for Malignant Pleural Effusion. J Oncol Pract 2018; 14:e547-e556. [DOI: 10.1200/jop.18.00201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: Readmission after hospitalization for malignant pleural effusion (MPE) may represent gaps in the quality of health care delivery. The goal of this study was to determine the frequency of 30-day readmission for MPE and identify clinical factors associated with rehospitalization. Patients and Methods: A retrospective cohort of adults hospitalized for MPE from 2009 to 2011 was analyzed using an administrative database. The primary outcome was all-cause 30-day readmission rate. Hierarchic mixed-effects logistic regression models were used to examine associations between patient- and hospital-level factors and 30-day readmission and assess variation in readmission rates across hospitals. Results: The 7-, 14-, 30-, 60-, and 90-day readmission rates for MPE were 16.1%, 25.9%, 38.3%, 52.5%, and 63.8%, respectively. The most common primary diagnoses for 30-day readmission were MPE (69.5%) and other clinical issues related to malignancy (21.1%). Clinical factors associated with 30-day readmission were female sex (odds ratio [OR], 0.78; 95% CI, 0.63 to 0.95), greater number of medical comorbidities (OR, 1.51; 95% CI, 1.15 to 1.99), and having a do-not-resuscitate order (OR, 1.37; 95% CI, 1.03 to 1.84). Hospitals in the 90th percentile were only 1.1 times more likely to have a 30-day readmission for MPE than those in the lowest 10th percentile (40.9% v 37%). Conclusion: Readmission for MPE is common and frequently results from progression of malignancy. Readmission rates were similar across all hospitals, suggesting they are unlikely to be mutable using conventional approaches to reduce rehospitalizations. Instead, interventions may need to focus on addressing care planning at the end of life.
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Affiliation(s)
- Theresa S. Yang
- Harbor–University of California Los Angeles Medical Center, Torrance, CA
| | - David W. Hsia
- Harbor–University of California Los Angeles Medical Center, Torrance, CA
| | - Dong W. Chang
- Harbor–University of California Los Angeles Medical Center, Torrance, CA
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Demmy TL. Optimizing the study of tunneled intrapleural catheters for malignant pleural effusions. J Thorac Cardiovasc Surg 2018; 156:1255-1259.e1. [PMID: 29935793 DOI: 10.1016/j.jtcvs.2018.04.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Todd L Demmy
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY.
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