Indwelling pleural catheter for malignant pleural effusions reduces care costs

Key takeaways:

• The average health care cost per patient in the indwelling pleural catheter (IPC) group was $40,179 vs. $46,640 CAD in the pleurodesis group.
• The number of inpatient days was also lower in the IPC group.

Twelve months after indwelling pleural catheter insertion vs. chemical pleurodesis for malignant pleural effusions, the average cost of health care was lower, according to results published in Annals of the American Thoracic Society.

Undergoing this type of procedure also meant fewer inpatient days afterward, according to researchers.

“Given the reduced health service use and costs associated with indwelling pleural catheters, outpatient programs and clinics that facilitate their insertion and management should be strongly supported and further developed,” Chanel Kwok, MD, staff interventional respirologist at The Ottawa Hospital and assistant professor at the University of Ottawa, told Healio. “Expanding these services can significantly increase the outpatient management of malignant pleural effusions.”

In a retrospective population-based study, Kwok and colleagues assessed 4,432 adults in Ontario with malignant pleural effusions who underwent indwelling pleural catheter (IPC) insertion with at-home drainage to find out how length of stay, readmissions, ED visits, home care visits and health care costs 12 months after the procedure differ from rates of adults in Ontario with malignant pleural effusions who underwent in-hospital chemical pleurodesis (n = 1,320).

All included patients underwent their procedure between January 2015 and December 2019.

A larger proportion of patients who received IPC insertion vs. chemical pleurodesis died in the assessed period (78.1% vs. 59.4%).

Researchers adjusted for baseline characteristic imbalances via inverse probability of treatment weighting.

Between the two sets of patients, the number of inpatient days was lower in the IPC insertion group vs. the chemical pleurodesis group both before weighting (10.1 days vs. 4.6 days) and after weighting (12.4 days vs. 16 days).

In the subgroup of individuals who underwent their procedure in an inpatient setting (n = 1,791 IPC; n = 1,320 pleurodesis), a discharge disposition of home with supports was more frequent in the IPC group (62.8% vs. 41.6%); however, a discharge disposition of home without supports was seen more often in the pleurodesis group (45.9% vs. 5.4%).

Among patients who underwent IPC insertion, 51.7% had a subsequent hospital admission for any cause, and this was similar to the rate observed among those who underwent chemical pleurodesis (52.6%).

Compared with the chemical pleurodesis group, more adults in the IPC insertion group had a subsequent admission for empyema (2.7% vs. 1.1%; P = .0002).

During the follow-up time period, researchers found that fewer patients in the IPC insertion group vs. the chemical pleurodesis group had visited the ED (61.9% vs. 65.1%). When divided by cause, more patients who underwent IPC insertion vs. chemical pleurodesis had ED visits for pleural effusions (12.8% vs. 10.6%; P = .0355).

In terms of home care nursing, hours spent using this service were higher among those with an IPC insertion vs. chemical pleurodesis (weighted mean, 41 hours vs. 21.1 hours).

The overall weighted average health care cost per patient in the IPC insertion group was $40,179, whereas in the chemical pleurodesis group this cost was $46,640.

“It was surprising to discover significant differences between patients who received IPCs and those who underwent chemical pleurodesis for managing malignant pleural effusions in the real world,” Kwok told Healio. “However, after adjusting for these differences, our findings aligned with those from previous randomized controlled trials: IPCs were associated with reduced subsequent health service use and costs.”

Moving forward, Kwok said research should evaluate the cost-effectiveness of IPCs vs. pleurodesis.

“Additional research will explore the significant differences between patients receiving these treatments and investigate strategies to overcome barriers to equal access to care,” Kwok added.