Use of pulmonary artery catheters provides no patient benefit and increases costs
Research Activities, June 2012, No. 382
Close monitoring of fluid status probably improves the outcome of patients sustaining acute lung injury. One way to achieve this is by inserting a catheter into the pulmonary artery to measure the hydrostatic pressure closest to lung tissue. Recent studies suggest that this approach does not improve hospital outcomes, although clinicians like the real-time data it provides. Now, a new study shows that a pulmonary artery catheter (PAC) has no greater advantage over a central venous catheter (CVC) and actually increases hospital costs.
Researchers compared the costs and long-term outcomes of both catheters using hospital billing information and interviews with patients who survived their injuries. They were interviewed at 2, 6, 9 and 12 months to determine how well they were doing, their quality of life (QOL), and what health care resources they were using after being released from the hospital. Final QOL data were analyzed on 210 patients who received a PAC and 219 patients who received a CVC.
Mortality rates increased from 2 months to 1 year, and survival at 1 year was similar for both groups. Among surviving patients, no differences in QOL were observed based on the type of catheter received. However, health care costs up to 1 year were higher for PAC patients ($61.1K) than for CVC patients ($45.4K). PAC use had a 75.2 percent probability of being more expensive and less effective. PACs incurred an average increased cost of $14.4K while at the same time yielding an average loss of 0.3 quality-adjusted life years. Overall, health care costs after discharge were significantly higher in PAC patients, with the biggest difference observed for rehabilitation costs. Given these current and past findings, the researchers recommend that PAC use should be restricted to patients with suspected pulmonary hypertension. The study was supported in part by the Agency for Healthcare Research and Quality (HS11620).
See "The effect of pulmonary artery catheter use on costs and long-term outcomes of acute lung injury," by Gilles Clermont, M.D., Lan Kong, Ph.D., Lisa A. Weissfeld, Ph.D., and others in PLoS One 6(7) e22512, pp. 1-10, 2011.