An indwelling pleural catheter may be the most effective way to deal with malignant pleural effusions in mesothelioma patients, but it can also be very costly.
Spanish researchers reached that conclusion after evaluating four different studies including 152 patients.
Their analysis shows that IPCs do help people with malignant pleural effusions feel better. But the procedure tends to be more complicated in people with pleural mesothelioma. This can make it much more expensive for them.
The Problem of Malignant Pleural Effusions
Malignant pleural effusions occur when fluid builds up between the layers of the pleural membrane surrounding the lungs. It is a common problem in people with advanced mesothelioma and several other types of cancer.
The fluid is a byproduct of the body’s attempt to fight the growing cancer. But if it is not dealt with, it can cause many life-limiting symptoms. Patients with malignant pleural effusions may get short of breath. They may also have chest pain, coughing, and fatigue as the fluid puts pressure on the lungs.
There are two main ways to help these symptoms. One way is to close up the space where the fluid is collecting. This requires a surgical procedure called pleurodesis. Doctors use chemicals or an irritant like talc to trigger scarring that fills in the pleural space. This may fix the problem permanently.
A less invasive way to treat malignant pleural effusions is to drain the fluid with a needle or with a catheter that stays in the body. The catheter approach should be cheaper. But complications can drive up the cost. The goal of the new Spanish study was to determine how expensive the indwelling pleural catheter (IPC) approach really is.
Counting the Cost of IPC
The Spanish researchers compared the costs and outcomes of 152 patients with malignant pleural effusions. Some of the patients had pleural mesothelioma. The team concluded that IPCs improved symptoms and quality of life for most patients. Most did not have to have more than one procedure to place the catheter.
But IPCs also caused their share of complications. The most common complication was infection. About nine percent of IPC patients had to be hospitalized because of complications.
These complications drove up the cost of treating malignant pleural effusions, especially in people with malignant mesothelioma.
“The average cost of IPC (set/drainage bottles) ranged from €2,025.6 [$2490] to €1,200.5 [$1476} if it was placed on an outpatient basis, €1,100 [$1352] if survival was <6 weeks, and €4,028 [$4953] in patients with mesothelioma,” writes study author Maribel Botana-Rial with Hospital Álvaro Cunqueiro, Vigo, Spain.
For patients who survived less than 14 weeks after the procedure, the cost of an IPC was much less than a pleurodesis procedure.
But some patients needed additional tests, follow-up visits, hospitalization, or home care. For them, the cost of an IPC for malignant pleural effusions could be more than €5,000 ($6148).
The researchers suggest that one way to keep costs down for mesothelioma patients and others is to place IPCs in an outpatient setting. Mesothelioma patients considering IPC or pleurodesis should discuss the risks, benefits, and costs of both options with their doctor.
Botana-Rial, M, et al, “Cost-Effectiveness of Malignant Pleural Effusion with Indwelling Catheter: Systematic Review”, December 30, 2020, Journal of Palliative Medicine, Online ahead of print, https://www.liebertpub.com/doi/10.1089/jpm.2020.0695