Background Extravasation is a potential complication associated with administration of intravenous therapy in cancer patients. In recent years, technological progress has led to the implementation and development of new central venous access systems (PICC: peripherally inserted central catheter and PORT) to enhance security in the process of administration and the patient's quality of life. The economic impact of these innovations, considering the volume of use in clinical practice, is not negligible in view of the potential complications that may arise. Aims The work was conducted with the objective of evaluating the impact of the problem of extravasation at the European Institute of Oncology (IEO) and the management arrangements taken by the operator. The economic impact of the placement and management of the two central venous access systems used in IEO, was also evaluated. Materials and methods An update of the internal procedure of extravasation management was conducted, having performed a systematic review of the literature. The extravasation’s reporting forms within the Institute were collected and an Excel database was created. A budget impact analysis (BIA), according to the principles IPSOR, was conducted to assess the economic impact of the choice of the device. The two system settings (PICCs and PORT), according to the local perspective and the Regional Health Service, were compared. The sensitivity analysis allowed to assess the possible cost scenarios associated with potential complications that can occur frequently in clinical practice. Results From the analysis of the period reporting forms collected between 2005 and 2015 it showed that extravasation from peripheral venous access were 81, central venous access 4. The number of PICCs placed in 2013 was 118 with a cost from the structure of € 28,320.00, 211 in 2014 for a cost of € 50,640.00 and 360 in 2015 at a cost of € 86,400.00. The number of PORTs positioned in 2013 was 168 at a cost of € 21,504.00, 184 in 2014 at a cost of € 23,000.00, 214 in 2015 at a cost of € 26,750.00. The estimated cost for each dependent patient of the hospital for the placement of the PICCs and PORTs systems, respectively, is about € 435.96 and € 638.61. Currently there is not a regional reimbursement rates for services provided in inpatient and day hospital. The positioning of the devices is part of the MAC performance package (MAC11 for the PORT system, MAC01-02-03 for PICC system) depending on the type associated with chemotherapy, according to Resolution No. IX / 2946 of the Lombardy Region. The complications of the sensitivity analysis provided the following data: the management of thromboembolism has a cost of € 1,346.47, the catheter-related infections of € 183.70 and € 665.00 for the management of pneumothorax (from PORT). It cannot however estimate the cost of complications from extravasation due to lack of information about it. Conclusions The hospital pharmacist plays a central role in addressing the critical issues in the clinical setting, with particular attention to the appropriateness prescriptive, the clinical risk and streamlining of economic resources assigned by promoting clinical excellence environment compatible with the assigned economic resources. With a view to prevention of complications should choose the appropriate venous access device. The PICC has a lower cost of positioning but it is associated with an increased risk of complications. The PORT’s implant has higher cost, but the risk of complications is lower. Considering the significant data it was desiderable to give more value to patient’s quality life to enable a more conscious choice.
Background: Lo stravaso è una potenziale complicanza legata alla somministrazione della terapia intravenosa nel paziente oncologico. Negli ultimi anni, il progresso tecnologico ha portato all’implementazione e sviluppo di nuovi sistemi di accesso venoso centrale (PICC: peripherally inserted central catheter e PORT) per migliorare la sicurezza in fase di somministrazione e la qualità di vita del paziente. L’impatto economico di queste innovazioni, considerando i volumi di utilizzo nella pratica clinica, non è trascurabile anche a fronte delle potenziali complicanze che possono insorgere. Obiettivi: Il lavoro è stato condotto con l’obiettivo di valutare l’impatto della problematica dello stravaso presso l’Istituto Europeo di Oncologia (IEO) e le modalità di gestione intraprese dall’operatore. È stato inoltre valutato l’impatto economico del posizionamento e della gestione dei due sistemi di accesso venoso centrale più utilizzati in IEO. Materiali e metodi: È stato condotto l’aggiornamento della procedura interna di gestione dello stravaso, dopo aver effettuato una revisione sistematica della letteratura. Sono state inoltre raccolte le schede di segnalazione di stravaso all’interno dell’Istituto ed è stato creato un database Excel. Per valutare l’impatto economico della scelta del dispositivo, è stata condotta una budget impact analysis (BIA) secondo i principi IPSOR confrontando i due setting di impianto (PICC e PORT) secondo la prospettiva locale e del servizio sanitario regionale (SSR). L’analisi di sensibilità ha permesso di valutare i possibili scenari di costo associati alle potenziali complicanze che possono verificarsi frequentemente nella pratica clinica. Risultati: Dall’analisi delle schede di segnalazione raccolte nel periodo compreso tra il 2005 ed il 2015 è emerso che gli stravasi da accesso venoso periferico sono stati 81, da accesso venoso centrale 4. Il numero di PICC posizionati nel 2013 è stato di 118 per una spesa a carico della struttura pari a € 28,320.00, 211 nel 2014 per un costo di € 50,640.00 e 360 nel 2015 per un costo di € 86,400.00. Il numero di PORT posizionati nel 2013 è stato di 168 per un costo di € 21,504.00, 184 nel 2014 per un costo di € 23,000.00, 214 nel 2015 per un costo di € 26,750.00. La spesa stimata per singolo paziente a carico della struttura ospedaliera per il posizionamento rispettivamente del sistema PICC e PORT è di circa € 435,96 e € 638,61. Attualmente non è prevista una tariffa di rimborso regionale per le prestazioni effettuate in regime di ricovero ordinario e di day hospital. Il posizionamento dei dispositivi rientra nel pacchetto di prestazioni MAC (MAC11 per l’impianto PORT, MAC01-02-03 per l’impianto PICC) a seconda della tipologia di trattamento chemioterapico associato, secondo la delibera n° IX/2946 della Regione Lombardia. L’analisi di sensibilità delle complicanze ha fornito i seguenti dati: la gestione del tromboembolismo presenta un costo di € 1,346.47, le infezioni catetere-correlate di € 183.70 e di € 665,00 per la gestione del pneumotorace (da PORT). Non è possibile invece stimare il costo della complicanza da stravaso per mancanza di dati a riguardo. Conclusioni: In un’ottica di prevenzione delle complicanze è opportuno scegliere il dispositivo di accesso venoso adeguato. Il PICC presenta un costo di posizionamento inferiore rispetto al PORT ma ad esso vi è associato un maggior rischio di complicanze. Il PORT ha un costo di impianto maggiore, ma il rischio di complicanze è minore. Alla luce dei dati emersi sarebbe auspicabile valutare l’impatto sulla qualità di vita del paziente per permettere una scelta più consapevole.
Il ruolo del farmacista nella scelta del dispositivo per l’accesso venoso centrale nella prevenzione dello stravaso e altre complicanze: un esempio di Budget Impact Analysis presso l’Istituto Europeo di Oncologia (IEO)
DUTTO, SOFIA
2015/2016
Abstract
Background Extravasation is a potential complication associated with administration of intravenous therapy in cancer patients. In recent years, technological progress has led to the implementation and development of new central venous access systems (PICC: peripherally inserted central catheter and PORT) to enhance security in the process of administration and the patient's quality of life. The economic impact of these innovations, considering the volume of use in clinical practice, is not negligible in view of the potential complications that may arise. Aims The work was conducted with the objective of evaluating the impact of the problem of extravasation at the European Institute of Oncology (IEO) and the management arrangements taken by the operator. The economic impact of the placement and management of the two central venous access systems used in IEO, was also evaluated. Materials and methods An update of the internal procedure of extravasation management was conducted, having performed a systematic review of the literature. The extravasation’s reporting forms within the Institute were collected and an Excel database was created. A budget impact analysis (BIA), according to the principles IPSOR, was conducted to assess the economic impact of the choice of the device. The two system settings (PICCs and PORT), according to the local perspective and the Regional Health Service, were compared. The sensitivity analysis allowed to assess the possible cost scenarios associated with potential complications that can occur frequently in clinical practice. Results From the analysis of the period reporting forms collected between 2005 and 2015 it showed that extravasation from peripheral venous access were 81, central venous access 4. The number of PICCs placed in 2013 was 118 with a cost from the structure of € 28,320.00, 211 in 2014 for a cost of € 50,640.00 and 360 in 2015 at a cost of € 86,400.00. The number of PORTs positioned in 2013 was 168 at a cost of € 21,504.00, 184 in 2014 at a cost of € 23,000.00, 214 in 2015 at a cost of € 26,750.00. The estimated cost for each dependent patient of the hospital for the placement of the PICCs and PORTs systems, respectively, is about € 435.96 and € 638.61. Currently there is not a regional reimbursement rates for services provided in inpatient and day hospital. The positioning of the devices is part of the MAC performance package (MAC11 for the PORT system, MAC01-02-03 for PICC system) depending on the type associated with chemotherapy, according to Resolution No. IX / 2946 of the Lombardy Region. The complications of the sensitivity analysis provided the following data: the management of thromboembolism has a cost of € 1,346.47, the catheter-related infections of € 183.70 and € 665.00 for the management of pneumothorax (from PORT). It cannot however estimate the cost of complications from extravasation due to lack of information about it. Conclusions The hospital pharmacist plays a central role in addressing the critical issues in the clinical setting, with particular attention to the appropriateness prescriptive, the clinical risk and streamlining of economic resources assigned by promoting clinical excellence environment compatible with the assigned economic resources. With a view to prevention of complications should choose the appropriate venous access device. The PICC has a lower cost of positioning but it is associated with an increased risk of complications. The PORT’s implant has higher cost, but the risk of complications is lower. Considering the significant data it was desiderable to give more value to patient’s quality life to enable a more conscious choice.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/19752