Elements for a cost-utility analysis of long-term venous access devices.

Three long-term intravenous infusion strategies were compared namely an imp lantable port OF), a tunneled central catheter (TCC), and repeated peripher al catheterization (RPC). PL decision analysis model was used in which the sequence of decisions and their possible consequences was described as a de cision tree for each of the three strategies. The likelihood of each event occurring was determined based on a literature review. Each event was assig ned a cost and a utility. Direct medical costs for the society include the cost of the material, the cost of implantation and removal of the device in the operating room, and the cost of treating complications directly ascrib able to the strategy used. Utility is a combination of efficacy las evaluat ed based on the likelihood of use of the strategy for one year) and quality of life las evaluated by experts). In the basic analysis, RPC was the most cost-saving method but had an adverse effect on quality of life (0.82). Th e cost of using IC or TCC for one year was higher, with the main contributo rs to the excess cost being the insertion procedure and the management of c omplications (primarily deep vein thrombosis and infection). Quality of lif e was better with IC (0.98) than with TCC (0.93), IC also had a higher cost -utility ratio (11738 French francs [FF]) versus 17393 FF), A one-way sensi tivity comparison of IC and TCC showed that the only realistic change capab le of reversing the order between these two methods was a decrease by one-t hird in the risk of infection with TCCs. This model, used here for the firs t time, establishes that IC is superior over TCC.