3:48 PM; Abstract No. 269 - Repeat large volume paracentesis vs. tunneled peritoneal catheter placement for malignant ascites: a cost-minimization study

• Published in: Journal of vascular and interventional radiology Vol. 25; no. 3; p. S126
• Main Authors: Bohn, K.A., Ray, C.E.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.03.2014
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2013.12.341

To determine at what point tunneled peritoneal catheter placement becomes less costly than repeat large volume paracenteses for patients with malignant ascites. Paracentesis and peritoneal tunneled catheter placement costs were based on 2013 Medicare reimbursement rates (based on geographic practice cost index - GPCI - for Colorado). Rates for specific complications were obtained from the literature and were also assigned associated costs based on GPCI allowable reimbursement. A decision tree-based hybrid Markov-Monte Carlo model was designed for 11 cycles of 10 days each and repeated for a total of 2500 subjects. Patients were grouped according to initial treatment decision (repeat paracentesis vs. tunneled peritoneal catheter), and the total cost at the end of each 10-day cycle was calculated. The point at which tunneled catheter placement became less costly than repeat paracentesis was determined. Anticipated outcomes were comparable to event probabilities derived from the model (all <3% variance), confirming validity of the model. The event cost for initial uncomplicated tunneled catheter placement was $2442.03 with a repeated cost of $224.63 per 10-day cycle; the event cost for an uncomplicated paracentesis was $501.43. When complication costs were included in the model, the cost curves crossed at 75.4 + 2.4 days (range 72.5-79.4), corresponding to the time period between paracentesis procedure numbers eight and nine. In patients with malignant ascites, repeat paracentesis becomes more costly once the procedure is performed between eight and nine times, or at approximately 75 days if paracentesis is repeated every 10 days.