14. Early Cost Comparison between Tube Thoracostomy vs. Chronic Indwelling Pleural Catheter (Pleurx®) for Treatment of Malignant Pleural Effusion.

Joe B. Putnam, Jr., Jack A. Roth, Garrett L. Walsh, Stephen G. Swisher, Kelly D. Willis, Linda L. DeFord

The University of Texas, M.D. Anderson Cancer Center

Houston, Texas

Previous studies have shown that a chronic indwelling pleural catheter safely and effectively relived dyspnea from malignant pleural effusion (MPE), maintained quality of life, and reduced hospitalization. We hypothesized that outpatient management with the Pleurx® catheter would reduce length of stay (LOS) and early (seven day) charges compared to inpatient treatment with chest tube (CT), drainage, sclerosis I patients with MPE, CT group; 68 consecutive inpatients (1/1/94 - 12/31/97); Pleurx group 47 patients (27 outpatients, 20 inpatients; 6/1/94 - 1/31/98). Demographics (gender, race and age) were similar in both groups Primary histology included lung (n=40,35 percent), breast (n=32, 28 percent), or other (n=43, 37 percent), median survival was 3.4 months and did not differ between treatment groups. Pretreatment cytology was positive in 83 patients. Overall median LOS was seven days for CT vs zero days for Pleurx (p=0.004).

Median impatient Pleurx LOS was five days (p=0.560 vs CT). Early (seven day) median charges were $8.54 for all patients (outpatient Pleurx $2,753, inpatient Pleurx $10000, CT, $9,414).

Mean charges were lower for outpatient Pleurx ($4,286 = 2446 S.D.) s CT ($9,843 +/-5311 S.D., p<0.001) and similar for impatient Pleurx ($12,207 +/- 10.119 S.D.) s. CT (p=0.168). We conclude that the early cost of care for MPS is reduced in outpatient Pleurx patients compared to impatient Pleurx and CT patients.