Economic analysis: PICC versus short catheter for prolonged home antibiotic therapy
DOI:
https://doi.org/10.15649/cuidarte.4124Keywords:
Outpatients, Catheterization Peripheral, Catheters, Catheter-Related Infections, Deep Vein ThrombosisAbstract
Highlights
- Guidelines recommend using peripherally inserted central catheters for treatment lasting more than 14 days.
- This study suggests that, compared to short peripheral catheters, peripherally inserted central catheters are more effective in preventing minor complications and subsequent catheter failure during prolonged parenteral antimicrobial therapy.
- Peripherally inserted central catheters remain more expensive than short peripheral catheters due to higher insertion and material costs.
- Nurse-led insertion of peripherally inserted central catheters may reduce costs for patients requiring prolonged parenteral antimicrobial therapy, leading to possible reductions in the incremental cost-effectiveness ratio.
Introduction: Hospital-at-home programs rely on vascular access devices for secure administration of parenteral antimicrobials. While guidelines recommend peripherally inserted central catheters (PICC) for treatments ≥14 days, short peripheral catheters (SPC) are often used instead. Cost-effectiveness studies comparing these devices and their complications are limited. Objective: This study conducted an economic evaluation comparing PICC and SPC for patient outpatient parenteral antibiotic therapy. Materials and Methods: A literature review of catheter complication frequencies yielded 1053 papers, narrowed to 18 after independent peer review. Experts were consulted, and a list of items required for catheter use was compiled to determine costs. A decision tree model was developed based on complication frequencies and costs. Results were analyzed using incremental cost-effectiveness ratios (ICER), univariate sensitivity analysis (tornado diagram), and multivariate sensitivity analysis (Monte Carlo simulation). Results: Major complications were similar between devices, but minor complications were more frequent with SPC. The PICC reference case assumed 50%-50% radiologist/nurse insertion, catheter cost ($74,7), ≤15-day treatment, and complication prevalence. Higher costs associated with PICC were linked to catheter material and radiologist insertion. Multivariate analysis showed ICERs of $49,2 with 90% nurse-led insertion and $24,3 with 100% nurse-led insertions, assuming a 50% PICC price reduction. Discussion: PICC was more effective in reducing minor complications. Costs decreased with nurse-led insertions and lower catheter material costs. Conclusions: Increasing PICC use for extended treatments could reduce overall costs and lower ICERs, highlighting their potential economic advantage despite higher initial expenses.
How to cite this article: Vélez- Bonilla Mariana, Hernández- Flórez Catalina, Solano-Felizzola Allan, Amado-Garzón Sandra B, Rosselli Diego. Economic analysis: PICC versus short catheter for prolonged home antibiotic therapy. Revista Cuidarte. 2025;16(2):e4124. https://doi.org/10.15649/cuidarte.4124
References
Cotta RMM, Morales M, Llopis A, Cotta JS, Real ER, Días JA. La hospitalización domiciliaria: antecedentes, situación actual y perspectivas. em>Rev Panam Salud Pública 2001;1;45-55. https://pubmed.ncbi.nlm.nih.gov/11558249/
Norris AH, Shrestha NK, Allison GM, Keller SC, Bhavan KP, Zurlo JJ et al. 2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapy. Clin Infect Dis 2018;68(1):e1-e35. https://doi.org/10.1093/cid/ciy745
Infectious Diseases Society of America-IDSA. Outpatient Parenteral Antimicrobial Therapy for Infectious Diseases. 3 ed. New York. 2016, CRG publishing. p10-190. Available from: https://www.idsociety.org/journals--publications/opat-e-handbook/
Pittiruti M, Van Boxtel T, Scoppettuolo G, Carr P, Konstantinou E, Ortiz G, et al. European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): A WoCoVA project. J Vasc Access. 2023;24(1):165-182. https://doi.org/10.1177/11297298211023274
Chopra V, Flanders S, Saint S, Woller SC, O’Grady NP, Safdar N, et al. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results from a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Ann Intern Med 2015;163(6):S1-40. https://doi.org/10.7326/M15-0744
Gorski LA, Hadaway L, Hagle ME, Broadhurst D, Clare S, Kleidon T, et al. Infusion Therapy Standards of Practice, 8th Edition. J Infus Nurs. 2021;44(1): S1–224. https://doi.org/10.1097/NAN.0000000000000396
López Cortés LE, Martínez AM, de Mandajona MFM, Martín N, Bermejo MG, Aznar JS, et al. Executive summary of outpatient parenteral antimicrobial therapy: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases and the Spanish Domiciliary Hospitalization Society. Enferm Infecc Microbiol Clin. 2019;37(6):405–9. https://doi.org/10.1016/j.eimc.2018.03.012
Grau D, Clarivet B, Lotthé A, Bommart S, Parer S. Complications with peripherally inserted central catheters (PICCs) used in hospitalized patients and outpatients: A prospective cohort study. Antimicrob Resist Infect Control. 2017;6(1). https://doi.org/10.1186/s13756-016-0161-0
Alexandrou E, Ray-Barruel G, Carr PJ, Frost S, Inwood S, Higgins N, et al. international prevalence of the use of peripheral intravenous catheters. J Hosp Med. 2015;10(8):530-3. https://doi.org/10.1002/JHM.2389
Helm RE, Klausner J, Klemperer JD, Flint LM, Huang E. Accepted but Unacceptable: Peripheral IV Catheter Failure. J Infus Nurs. 2015;38(3):189-203. https://doi.org/10.1097/NAN.0000000000000100
Seo H, Altshuler D, Dubrovskaya Y, Nunnally ME, Nunn C, Ello N, et al. The Safety of Midline Catheters for Intravenous Therapy at a Large Academic Medical Center. Ann Pharmacother. 2020;54(3):232-238. https://doi.org/10.1177/1060028019878794
Schneider LV, Duron S, Arnaud FX, Bousquet A, Kervella Y, Bouzad C, et al. Evaluation of PICC complications in orthopedic inpatients with bone infection for long-term intravenous antibiotics therapy. J Vasc Access. 2015;16(4):299-308. https://doi.org/10.5301/JVA.5000389
Periard D, Monney P, Waeber G, Zanetti G, Wasserfallen JB, Denys A, et al. Randomized controlled trial of peripherally inserted central catheters vs. peripheral catheters for middle duration in-hospital intravenous therapy. J Thromb Haemost. 2008;6(8):1281-8. https://doi.org/10.1111/j.1538-7836.2008.03053.x
Zhaoxin D, Connolly BL, Ungar WJ, Coyte PC. Cost analysis of peripherally inserted central catheter in pediatric patients. Int J Technol Assess Health Care 2018;34(1):38-45. https://doi.org/10.1017/S026646231700109X
Schwengel DA, McGready J, Berenholtz SM, Kozlowski LJ, Nichols DG, Yaster M. Peripherally inserted central catheters: a randomized, controlled, prospective trial in pediatric surgical patients. Anesth Analg. 2004;99(4):1038–43. DOI: https://doi.org/10.1213/01.ANE.0000132547.39180.88
Federación de Aseguradores Colombianos-Fasecolda Acuerdo 256 de 2001 Por el cual se aprueba el “manual de tarifas” de la entidad promotora de salud del seguro social “eps-iss”. December 2001. Consulta: Octubre 19, 2023. Disponible en: https://www.fasecolda.com/ramos/soat/tarifas-y-coberturas/manual-tarifario-de-salud/
Chopra V, O’Horo JC, Rogers MA, Maki DG, Safdar N. The Risk of Bloodstream Infection Associated with Peripherally Inserted Central Catheters Compared with Central Venous Catheters in Adults: A Systematic Review and Meta-Analysis. Infect Control Hosp Epidemiol. 2013;34(9):908–18. https://doi.org/10.1086/671737
Safdar N, Maki DG. Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest. 2005;128(2):489–95. https://doi.org/10.1378/chest.128.2.489
Vélez M, Hernández C, Martínez S, Parra MJ, Moreno J. Uso del PICC para manejo antimicrobiano parenteral prolongado en un programa de hospitalización domiciliaria. Conferencia ACISD: 2do congreso internacional de atención domiciliaria. Bogotá, Colombia marzo 24 2023. Consulta: octubre 19, 2023.
Agudelo JF, Aldana N, Álvarez S, Gómez CI, Rojas, PA. Catéteres Centrales insertados periféricamente (PICC) utilizados en el programa de antibioticoterapia ambulatoria del Hospital Pablo Tobón Uribe (HPTU). PhD thesis, Universidad CES, Colombia,2007. Fecha de consulta: 19/10/2023. Disponible en: https://repository.ces.edu.co/items/aaa8bd2f-bc12-442f-90f5-ff8e521848e5
Moreno Viscaya M, Mejía Mejía A, Castro Jaramillo HE. Manual para la elaboración de evaluaciones económicas en salud. Bogotá: Instituto de Evaluación Tecnológica en Salud. Consulta: Junio 01, 2021. Disponible en: https://www.iets.org.co/2014/11/13/manual-para-la-elaboracion-de-evaluaciones-economicas-en-salud/
Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, et al. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: Updated reporting guidance for health economic evaluations. Heal Policy OPEN. 2022;3. https://doi.org/10.1016/J.HPOPEN.2021.100063
Silberzweig JE, Sacks D, Khorsandi AS, Bakal CW. Reporting standards for central venous access. J Vasc Interv Radiol. 2003;14(9):S443-52. https://doi.org/10.1097/01.RVI.0000094617.61428.BC
Ouzzani M, Hammady H, Fedorowics Z, Elmagarmid A. Rayyan-a web, and mobile app for systematic reviews. Syst Rev. 2016;5(1). https://doi.org/10.1186/S13643-016-0384-4
Vélez-Bonilla M, Hernández-Flórez C, Solano-Felizzola A, Amado-Garzón SB, Rosselli D. Master dataset, Mendeley Data V1, (2024). https://doi.org/10.17632/x29jnn8ppj.1
Chen X, Liang M. A Meta-Analysis of Incidence of Catheter-Related Bloodstream Infection with Midline Catheters and Peripherally Inserted Central Catheters. J Health Eng 2022;(1). https://doi.org/10.1155/2022/6383777
Chopra V, Anand S, Hickner A, Buist M, Rogers MA, Saint S, et al. Risk of venous thromboembolism associated with peripherally inserted central catheters: A systematic review and meta-analysis. Lancet. 2013;382(9889):311–25. https://doi.org/10.1016/S0140-6736(13)60592-9
Bahl A, Karabon P, Chu D. Comparison of Venous Thrombosis Complications in Midlines Versus Peripherally Inserted Central Catheters: Are Midlines the Safer Option? Clin Appl Thromb Hemost. 2019;25. https://doi.org/10.1177/1076029619839150
Paauw JD, Borders H, Ingalls N, Boomstra S, Lambke S, Fedeson B, et al. The incidence of PICC line-associated thrombosis with and without the use of prophylactic anticoagulants. JPEN J Parenter Enteral Nutr. 2008;32(4):443–7. https://doi.org/10.1177/0148607108319801
González S, Jiménez P, Saavedra P, Macías D, Loza A, León C, et al. Five-year outcome of peripherally inserted central catheters in adults: a separated infectious and thrombotic complications analysis. Infect Control Hosp Epidemiol. 2021;42(7):833–41. https://doi.org/10.1017/ICE.2020.1300
Bouzad C, Duron S, Bousquet A, Arnaud FX, Valbousquet L, Weber-Donat G, et al. Peripherally Inserted Central Catheter-Related Infections in a Cohort of Hospitalized Adult Patients. Cardiovasc Intervent Radiol. 2016 Mar 1;39(3):385–93. https://doi.org/10.1007/s00270-015-1182-4
Swaminathan L, Flanders S, Horowitz, Zhang Q, O’Malley M, Chopra V. Safety and Outcomes of Midline Catheters vs Peripherally Inserted Central Catheters for Patients with Short-term Indications: A Multicenter Study. JAMA Intern Med. 2022;182(1):50–8. https://doi.org/10.1001/JAMAINTERNMED.2021.6844
Webster J, Osborne S, Rickard CM, Marsh N. Clinically indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev. 2019;1(1). https://doi.org/10.1002/14651858.CD007798.pub5
Marsh, N, Webster J, Ullman AJ, Mihala G, Cooke M, Chopra V, et al. Peripheral intravenous catheter non-infectious complications in adults: A systematic review and meta-analysis. J Adv Nurs 2020;76(12):3346-3362. https://doi.org/10.1111/jan.14565
Fan X, Xu L, Wei WS, Chen YM, Yang Y. Relationship between indwelling site and peripheral venous catheter-related complications in adult hospitalized patients: A systematic review and meta-analysis. J Clin Nurs. 2023;32(7–8):1014–24. https://doi.org/10.1111/JOCN.16241
Lu H, Yang Q, Mohamed H, Lv Yi, Zheng X, Xin X, et al. The safety of clinically indicated replacement or routine replacement of peripheral intravenous catheters: A randomized controlled study. J Vasc Access. 2022;23(3):436–42. https://doi.org/10.1177/1129729821998528
Liu C, Chen L, Kong D, Lyu F, Luan L, Yang L, et al. Incidence, risk factors and medical cost of peripheral intravenous catheter-related complications in hospitalized adult patients. J Vasc Access. 2022;23(1):57–66. https://doi.org/10.1177/1129729820978124
Dychter SS, Gold DA, Carson D, Haller M. Intravenous therapy: A review of complications and economic considerations of peripheral access. J Infus Nurs 2012;35(2):84-91. https://doi.org/10.1097/NAN.0b013e31824237ce
Wang K, Zhong J, Huang N, Zhou Y. Economic evaluation of peripherally inserted central catheter and other venous access devices: A scoping review. J Vasc Access 2020;21(6):826-837. https://doi.org/10.1177/1129729819895737
Chen YM, Fan XW, Liu MH, Wang J, Yang YQ, Su YF. Risk factors for peripheral venous catheter failure: A prospective cohort study of 5345 patients. J Vasc Access. 2022;23(6):911–21. https://doi.org/10.1177/11297298211015035
Walker G, Todd A. Nurse-led PICC insertion: Is it cost effective? Br J Nurs. 2013;22(19). https://doi.org/10.12968/bjon.2013.22.sup19.s9
Gallego-Aguirre L, Orozco-Hernández BE. Analysis of quality parameters and costs of using the central venous catheter of peripheral insertion versus the central insertion catheter in pediatric patients at Hospital Universitario del Valle, Cali Colombia 2011-2014. Infectio. 2020;24(2):108-111. https://doi.org/10.22354/in.v24i2.842
Cortés OL, Parra YM, Torres DA, Monroy P, Malpica JC, Pérez EP, et al. Evaluación de indicadores de un programa de dispositivos de Acceso Vascular liderado por profesionales de enfermería en un hospital universitario de alta complejidad en Colombia. Investigación y Educación en Enfermería. 2022;40(1):e12. https://doi.org/10.17533/udea.iee.v40n1e12
Published
How to Cite
Downloads
Issue
Section
Categories
License
Copyright (c) 2025 Revista Cuidarte
This work is licensed under a Creative Commons Attribution 4.0 International License.
Journal Cuidarte, scientific publication of open access, is licensed under a Creative Commons Attribution (CC BY-NC), which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Any other form of use such as reproduction, transformation, public communication or distribution, for profit, requires the prior authorization of the University of Santander UDES.
The names and e-mail addresses entered in the Journal Cuidarte will be used exclusively for the purposes stated by this magazine and will not be available for any other purpose or other person.
The articles published in the Journal Cuidarte represent the criteria of their authors and do not necessarily constitute the official opinion of the University of Santander UDES.
