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Original Research: Disorders of the Pleura |

Comparing Cost of Indwelling Pleural Catheter vs Talc Pleurodesis for Malignant Pleural EffusionCost Analysis of Malignant Pleural Effusions

Erika D. Penz, MD; Eleanor K. Mishra, DPhil; Helen E. Davies, MD; Braden J. Manns, MD; Robert F. Miller, MBBS; Najib M. Rahman, DPhil
Author and Funding Information

From the Department of Medicine (Dr Penz), University of Saskatchewan, Saskatoon, SK, Canada; the Oxford Respiratory Trials Unit (Drs Mishra and Rahman) and National Institute for Health Research Oxford Biomedical Research Centre (Dr Rahman), University of Oxford, Oxford, England; the University Hospital of Wales (Dr Davies), Cardiff, Wales; the Departments of Medicine and Community Health Sciences (Dr Manns), University of Calgary, Calgary, AB, Canada; and the Research Department of Infection and Population Health (Dr Miller), University College London, London, England.

CORRESPONDENCE TO: Erika D. Penz, MD, Rm 565 Ellis Hall, Royal University Hospital, 103 Hospital Dr, Saskatoon, SK, S7N 0W8, Canada; e-mail: erika.penz@usask.ca


Part of this article has been published in abstract form (Penz E, Mishra E, Davies H, Manns B, Rahman N. Am J Respir Crit Care Med. 2013:A2152) and presented in poster form at the American Thoracic Society International Conference, May 17-22, 2013, Philadelphia, PA.

FUNDING/SUPPORT: The TIME2 trial was supported with an unrestricted education grant from the British Lung Foundation and the Robert Luff Foundation, London, England. The University of Oxford sponsored the TIME2 trial. The IPCs and drainage bottles were provided by Rocket Medical PLC, Washington, England. An Alberta Innovates Health Solutions Clinician Fellowship award supported Dr Penz during her involvement in the analysis and preparation of the manuscript. Dr Manns is supported by Alberta Innovates – Health Solutions salary award and by an alternative funding plan from the Government of Alberta and Universities of Alberta and Calgary.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(4):991-1000. doi:10.1378/chest.13-2481
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BACKGROUND:  Malignant pleural effusion is associated with short life expectancy and significant morbidity. A randomized controlled trial comparing indwelling pleural catheters (IPCs) with talc pleurodesis found that IPCs reduced in-hospital time and the need for additional procedures but were associated with excess adverse events.

METHODS:  Using data from the clinical trial, we compared costs associated with use of IPCs and with talc pleurodesis. Resource use and adverse events were captured through case report forms over the 1-year trial follow-up. Costs for outpatient and inpatient visits, diagnostic imaging, nursing, and doctor time were obtained from the UK National Health Service reference costs and University of Kent’s Unit Costs of Health and Social Care 2011 and inflated to 2013 using the UK Consumer Price Index. Procedure supply costs were obtained from the manufacturer. Difference in mean costs was compared using nonparametric bootstrapping. All costs were converted to US dollars using the Organisation for Economic Co-operation and Development Purchasing Power Parity Index.

RESULTS:  Overall mean cost (SD) for managing patients with IPCs and talc pleurodesis was $4,993 ($5,529) and $4,581 ($4,359), respectively. The incremental mean cost difference was $401, with 95% CI of −$1,387 to $2,261. The mean cost related to ongoing drainage in the IPC group was $1,011 ($732) vs $57 ($213) in the talc pleurodesis group (P = .001). This included the cost of drainage bottles, dressing changes in the first month, and catheter removal. There was no significant difference in cost of the initial intervention or adverse events between the groups. For patients with survival < 14 weeks, IPC is significantly less costly than talc pleurodesis, with mean cost difference of −$1,719 (95% CI, −$3,376 to −$85).

CONCLUSIONS:  There is no significant difference in the mean cost of managing patients with IPCs compared with talc pleurodesis. For patients with limited survival, IPC appears less costly.

TRIAL REGISTRY:  isrctn.org; No.: ISRCTN87514420; URL: www.isrctn.org

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