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Tunneled Peritoneal Catheter vs Repeated Paracenteses for Recurrent Ascites: A Cost-Effectiveness Analysis

  • Clinical Investigation
  • Non-Vascular Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To compare the cost-effectiveness of tunneled peritoneal catheter (TPC) versus serial large-volume paracenteses (LVP) for patients with recurrent ascites.

Materials and Methods

Retrospective, single-institution analysis of 100 consecutive patients undergoing LVP and eventual TPC placement (2015–2018) was performed with extraction of procedural complications and hospital admissions. LVPs were associated with 17 adverse events (AEs) while only 9 AEs occurred after TPC placement. While undergoing routine LVP, the patients had 30 hospitalizations monthly (177 days in total) and 10 hospitalizations monthly (51 days) after TPC placement. A cost-effectiveness analysis with Markov modeling was performed comparing TPC and LVP. Costs were based on Medicare reimbursement rates. Statistical analyses include base case calculation, Monte Carlo simulations, and deterministic sensitivity analyses.

Results

TPC placement was the dominant strategy with a comparable health benefit of 0.08060 quality-adjusted life-years (QALY) (LVP: 0.08057 QALY) at a lower cost of $4151 (LVP: $8401). Probabilistic sensitivity analysis showed TPC was superior in 97.49% of simulations. Deterministic sensitivity analysis demonstrated the superiority of TPC compared to LVP if the TPC complication rate was < 9.47% per week and the complication rate for LVP was > 1.32% per procedure. TPC was more cost-effective when its procedural cost was < $5427 (base case: 1174.5), and remained as such when the cost of LVP was varied as much as $10,000 (base case: $316.48).

Conclusion

In this study, TPC was more cost-effective than LVP in patients with recurrent ascites due to the reduced risk of infection, emergency department visits, and length of hospitalization stays.

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, San Francisco, CA, 94143, USA

    Xiao Wu, Rana Rabei, Bradley King, Andrew Taylor & Michael Heller

  2. Division of Interventional Radiology, Stanford University, Stanford, CA, USA

    Eric J. Keller & Nishita Kothary

  3. Department of Radiology, University of North Carolina, Chapel Hill, NC, USA

    Maureen Kohi

Authors
  1. Xiao Wu
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  2. Rana Rabei
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  4. Bradley King
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  7. Andrew Taylor
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  8. Michael Heller
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Correspondence to Xiao Wu.

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For this type of study, formal consent is not required.

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This study has obtained IRB approval from University of California San Francisco, and the need for informed consent was waived.

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Consent for publication was obtained for every individual person's data included in the study.

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Wu, X., Rabei, R., Keller, E.J. et al. Tunneled Peritoneal Catheter vs Repeated Paracenteses for Recurrent Ascites: A Cost-Effectiveness Analysis. Cardiovasc Intervent Radiol 45, 972–982 (2022). https://doi.org/10.1007/s00270-022-03103-4

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  • DOI: https://doi.org/10.1007/s00270-022-03103-4

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