Cost-utility Analysis Of Different Venous Access In Cancer Patients Based On Decision Tree Model

Objective:The aim of this study was to obtain and compare the cost and health utility of different venous access in cancer patients and to investigate the influencing factors.The median indwelling time and complications of different venous accesses in cancer patients were also understood.To evaluate the cost-effectiveness of CVC(central venous catheter,CVC),PICC(peripherally inserted central catheter,PICC)and IVAP(implantablevenous access port,IVAP)venous catheter access for long-term chemotherapy in breast cancer patients.Provide reference information for clinical decision-making,and provide guidance for cancer patients and clinical selection of safe,effective and economical venous access.Methods:1.Part I: A total of 608 outpatients and inpatients in Sichuan Cancer Hospital were enrolled by convenience sampling from June 2021 to October 2021.A total of 608 patients with catheterization in the catheterization period were investigated by general data questionnaire and Euro Qol 5-dimensions 5-level(EQ-5D-5L).Rank sum test,ordinal multivariate logistic regression and Tobit model were used to analyze the differences in health utility of different venous accesses in cancer patients and their influencing factors.2.Part II: This study uses propensity score matching(PSM)to establish a retrospective cohort.Decision tree models were used to compare the cost-effectiveness of using three different venous accesses in breast cancer chemotherapy patients.Cost parameters were derived from data extracted from the outpatient and inpatient charge systems,and total costs included cost of placement,maintenance,extraction,and management of complications;utility parameters were derived from cross-sectional survey results in the first part of this study;and complication rates were derived from breast cancer catheterization patient information as well as follow-up information on complications that occurred.Quality adjusted life years(QALYs)were used for efficacy outcomes.Incremental Cost-Effectiveness Ratio(ICER)was used to compare the three strategies.In order to evaluate the uncertainty of model parameters,sensitivity analysis was carried out,including single factor sensitivity analysis and probabilistic sensitivity analysis.Results:1.Part 1: A total of 608 subjects were included in the cross-sectional survey in this study,and 69.7% of the total number of women could be obtained by descriptive statistical analysis;the mean utility value was 0.93,and the mean EQ-VAS score was84.55.Univariate analysis using rank sum test showed that gender,disease type,and catheterization type had an effect on health utility values(P < 0.01,P < 0.001,P <0.001)."11111" complete health status was reported by 27.4% of patients with a mean utility value of 1 and a mean EQ-VAS score of 89.44.The frequency of item responses in each dimension of EQ-5D-5L reported by type of insertion showed that few problems were reported in all three lines in the mobility dimension;in the self-care dimension,72.2% of patients were reported to have minor problems by CVC;in the daily activities dimension,25.4% of patients were reported to have minor problems by PICC;in the pain/discomfort dimension,all three lines reported varying proportions of minor problems;and in the anxiety/depression dimension,21.4% of patients were reported to have minor problems by PORT.Multivariate analysis using ordinal multivariate logistic regression showed that there were significant differences in the reporting of different TNM stages and catheterization types in the mobility dimension(P < 0.05,P < 0.05);there were significant differences in the reporting of different ethnic groups,different occupations,and different catheterization types in the self-care dimension(P < 0.05,P <0.05,P < 0.001);there were significant differences in the reporting of different genders and different catheterization types in the daily activities and pain/discomfort dimension(P < 0.01,P < 0.01);and there were significant differences in the reporting of TNM stages in the anxiety/depression dimension(P < 0.05).Multivariate Tobit regression showed that gender,occupation(enterprise employees,workers)and type of catheterization had an effect on mean health utility values(P < 0.001,P < 0.05,P <0.05);gender,ethnicity,disease type(breast cancer)and type of catheterization had an effect on mean EQ-VAS scores(P < 0.05,P < 0.05,P < 0.01,P < 0.05).2.Part 2: A total of 10,718 patients(3,780 after propensity score matching)were included in this study.In terms of cost-utility ratio,IVAP had the smallest cost-utility ratio and PICC had the largest cost-utility ratio when left in place for more than 12 months.In the incremental cost-utility analysis,the incremental cost-utility ratio of PICC for CVC was 2375.08 $/QALY,IVAP for PICC was 522.01 $/QALY,and IVAP for CVC was 612.98 $/QALY.Incremental cost-effectiveness ratios showed that IVAP was more effective than CVC and PICC.Model regression analysis showed that IVAP was recommended as the best regimen regardless of catheter indwelling time of 6months,12 months or more than 12 months.The reliability and stability of the model were verified by single factor sensitivity analysis and Monte Carlo simulation(probabilistic sensitivity analysis).Conclusions:1.We obtained health utility and VAS scores measured by EQ-5D-5L scale for different venous access in oncology patients.Through this study,we learned that different types of catheterization have different effects on patients’ health-related quality of life,and implantable venous access ports have better health utility and higher VAS scores compared with CVC,PICC.2.This study provides economic evidence for the selection of vascular access in breast cancer chemotherapy patients.In the clinical context of China,by comparing the cost-effectiveness of three vascular accesses for breast cancer chemotherapy patients,it is pointed out that IVAP is the most cost-effective regimen after establishing a decision tree model operation.