ECONOMIC RWD AND MCDA VALUE ASSESSMENT OF PERIPHERALLY INSERTED CENTRAL CATHETER (PICC) USE VERSUS CENTRALLY INSERTED CENTRAL CATHETER (CICC) IN HIGH-COMPLEXITY PATIENTS IN BRAZIL. AN HOSPITAL-PERSPECTIVE ECONOMIC MODEL ANALYSIS
Author(s)
ELIO TANAKA, MD1, Luciano da Silva Santos, RESEARCH2, Vivian Chien, MD3.
1MEDICAL AUDIT, TNK MEDICAL AUDIT INSTITUTION, CURITIBA, Brazil, 2TNK MEDICAL AUDIT INSTITUTION, São Paulo, Brazil, 3TNK MEDICAL AUDIT INSTITUTION, Sao Paulo, Brazil.
1MEDICAL AUDIT, TNK MEDICAL AUDIT INSTITUTION, CURITIBA, Brazil, 2TNK MEDICAL AUDIT INSTITUTION, São Paulo, Brazil, 3TNK MEDICAL AUDIT INSTITUTION, Sao Paulo, Brazil.
OBJECTIVES: To assess the real-world clinical/economic increase's value PICC versus CICC in complexity patients with hematologic/oncologic diseases or prolonged antibiotic therapy (>14 days) treated at three Brazilian tertiary hospitals .
METHODS: A hospital-perspective economic model was parameterized using event-attributable incremental length of stay (LOS). The analysis of 12-month horizon, reflecting 90 ICU beds across the three centers and 100 eligible patients/month (1,200 annually). Current practice (10% PICC/90% CICC) was compared with a proposed scenario (30% PICC/70% CICC), corresponding to 240 annual CICC-to-PICC conversions. Unit costs included device acquisition, insertion, and hospitalization costs, with a total hospital-day cost BRL 5,066. Outcomes included mortality, bloodstream infections, composite complications, and hospital days. Procedural effectiveness reflected observed placement success (PICC 93.9% vs CICC 89.8%). Costs were converted USD using a 1:5 exchange ratio. In parallel, a MCDA framework, aligned with ISPOR good-practice principles, synthesized stakeholder-weighted domains: clinical safety (mortality, infection, thrombosis, pneumothorax), effectiveness (procedural success), economic impact (net budget impact), and operational performance (LOS and bed-day release). Scenario analyses and deterministic one-way sensitivity analyses (±20% for key inputs) are reported.
RESULTS: Increasing PICC adoption reduced deaths by 8.9, infections by 27.0, complications by 49.8, and hospital days by 526.5 over 12 months. Despite higher upfront device costs (+USD 63.3k) and insertion-failure costs (+USD 2.0k), complication-related costs decreased by USD 533.5k, yielding net savings of USD 468.2k (−12% budget impact). Savings averaged USD 390/patient and USD 1,951/conversion, with 7.17 ROI and a payback period of 1.7 months. In the MCDA, PICC achieved a higher overall value score, primarily driven by reductions in infection and increased bed-day availabilitIy.
CONCLUSIONS: In Brazilian tertiary care, expanding PICC use in oncology/complex infection patients was clinically beneficial and economically dominant. MCDA adds transparent, decision-ready evidence by integrating outcomes, costs and operational gains to support adoption and implementation planning.
METHODS: A hospital-perspective economic model was parameterized using event-attributable incremental length of stay (LOS). The analysis of 12-month horizon, reflecting 90 ICU beds across the three centers and 100 eligible patients/month (1,200 annually). Current practice (10% PICC/90% CICC) was compared with a proposed scenario (30% PICC/70% CICC), corresponding to 240 annual CICC-to-PICC conversions. Unit costs included device acquisition, insertion, and hospitalization costs, with a total hospital-day cost BRL 5,066. Outcomes included mortality, bloodstream infections, composite complications, and hospital days. Procedural effectiveness reflected observed placement success (PICC 93.9% vs CICC 89.8%). Costs were converted USD using a 1:5 exchange ratio. In parallel, a MCDA framework, aligned with ISPOR good-practice principles, synthesized stakeholder-weighted domains: clinical safety (mortality, infection, thrombosis, pneumothorax), effectiveness (procedural success), economic impact (net budget impact), and operational performance (LOS and bed-day release). Scenario analyses and deterministic one-way sensitivity analyses (±20% for key inputs) are reported.
RESULTS: Increasing PICC adoption reduced deaths by 8.9, infections by 27.0, complications by 49.8, and hospital days by 526.5 over 12 months. Despite higher upfront device costs (+USD 63.3k) and insertion-failure costs (+USD 2.0k), complication-related costs decreased by USD 533.5k, yielding net savings of USD 468.2k (−12% budget impact). Savings averaged USD 390/patient and USD 1,951/conversion, with 7.17 ROI and a payback period of 1.7 months. In the MCDA, PICC achieved a higher overall value score, primarily driven by reductions in infection and increased bed-day availabilitIy.
CONCLUSIONS: In Brazilian tertiary care, expanding PICC use in oncology/complex infection patients was clinically beneficial and economically dominant. MCDA adds transparent, decision-ready evidence by integrating outcomes, costs and operational gains to support adoption and implementation planning.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE227
Topic
Economic Evaluation, Medical Technologies, Real World Data & Information Systems
Topic Subcategory
Thresholds & Opportunity Cost
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Infectious Disease (non-vaccine), Injury & Trauma, Oncology, Pediatrics