Peripherally inserted central catheters versus chemoports for patients with cancer in India: A health-economic evaluation

ABSTRACT Background: Central venous access devices (CVADs) including peripherally inserted central catheters (PICCs) and implanted vascular access ports (PORTs), are associated with adverse events comprising deep vein thrombosis (DVT), infections, and occlusions. The prioritization between PICCs and chemoports for infusing chemotherapy remains inconclusive and unclear. Objectives: The primary objective of study was to assess and compare the overall cost of therapy and the secondary objective was to evaluate the impact of varying indwelling periods on the total costs associated with chemoports and PICCs in India. Materials and Methods: This health economic evaluation study was conducted in the Department of health economics and outcome research, B. Braun Medical (India) Pvt. Ltd and B. Braun Medical Industries, Pulau Pinang, Malaysia during June 2023 - March 2024. We conceptualized a static decision tree model to assess the economic impact of using chemoports or PICCs in a hypothetical cohort of 100 hospitalized patients with cancer from a health system perspective, over a three-year time horizon. Input parameters included the incidence and cost of managing complications including DVT and infections, as well as device costs, including their insertion, maintenance, and removal expenses. We conducted scenario analyses with varying indwelling periods and sensitivity analyses to estimate the uncertainty in results. Results: The overall cost of therapy with chemoports and PICCs was INR 54,897,251.4 and INR 101,532,940.8, respectively, with a cost saving of INR 4,66,35,689.4 (45.9%) for chemoports (base case scenario). Scenario analyses revealed that savings increased with longer indwelling periods for chemoports, ranging from INR 83,67,066.5 (8.2%) for short-term use (137 days) to INR 6,59,87,295.2 (65%) for long-term use (593 days), compared to 59 days of PICC use. Sensitivity analyses confirmed the robustness of the results under varying input values at 95% confidence limits. Conclusion: This study highlights significant cost savings with chemoports over PICCs, advocating the use of chemoports for better patient outcomes and economic efficiency.