Treatment of Malignant Pleural Effusion: PleuRx ® Catheter or Talc Pleurodesis? A Cost-Effectiveness Analysis

作者：Aaron M. Olden, R. Holloway · 发表于：Journal of Palliative Medicine · 年份：2009 · DOI：10.1089/jpm.2009.0220 · 被引用次数：127 · 研究领域：Pleural and Pulmonary Diseases、Ultrasound in Clinical Applications、Occupational and environmental lung diseases

INTRODUCTION: Malignant pleural effusions (MPEs) complicate many advanced malignancies and the median prognosis for those who develop MPEs is 6 months. These effusions lead patients to suffer from significant dyspnea, which may consequently impair mobility and lead to reduced quality of life. There are several treatment options for those with MPE. Thoracentesis may be quick and relatively easy to perform, but has a high recurrence rate; chest tube placement with talc slurry is quite effective at achieving pleurodesis, but this procedure can be quite painful and requires hospitalization. An alternative option is outpatient placement of the Pleurx catheter (Denver Biomedical Inc., Denver, CO) for home-based drainage of effusions. OBJECTIVE: To determine the incremental cost effectiveness of treating MPE with talc pleurodesis versus placement of Pleurx catheter. METHODS: We used decision analysis to compare treatments for the management of MPE. Cost data for Pleurx and talc treatments were obtained using Medicare reimbursement data for 2008, and outcome data (probability of treatment success and/or complication, and utility of health states) were obtained through literature review. RESULTS: Under our base-case analysis, treatment with talc was less costly than Pleurx (talc, $8170.80; Pleurx, $9011.60) with similar effectiveness (talc, 0.281 quality adjusted life years [QALYs]; Pleurx, 0.276 QALYs). Pleurx became more cost effective (<$100K/QALY) when life expectancy was 6 weeks ...