(1) Teaching Hospital of Val Vibrata, Department of Anesthesia and Critical Care, Sant’Omero (Teramo) Italy
(2) Department of Cost Analysis and Control, HBG, Rome, Italy
* Corresponding author Email: email@example.com
Ultrasound guidance for cannulation of the internal jugular vein has been shown to improve success and complication rates in comparison with the landmark techniques.
The aim of this study is to verify if ultrasound is also cost-effective.
Materials and Methods
A systematic review of the literature in PubMed, Medline, and Google was performed between years 1966 and 2010. A decision tree model was built with failure and complication rates from the studies selected. A cost-effectiveness analysis and sensitivity analysis were performed with this model.
Randomised controlled trials on adult patients, with real-time B-mode ultrasound guidance, comparison between ultrasonography and landmark methods and reported outcomes (early complications, failures, time to successful cannulation) were included. Exclusion criteria were: enrolment of paediatric patients, ultrasound before puncture, Doppler ultrasound guidance, no clear description of outcomes, and no prospective clinical trial.
About 8 randomised controlled trials were selected. The ultrasound guidance significantly reduces the occurrence of arterial puncture (risk ratio, risk ratio 0.21, 95% CI 0.13–0.33), pneumothorax complications (risk ratio 0.15, 95% CI 0.03–0.88), and cannulation failures (R 0.12, 95% CI 0.04-0.39). It proves to have € 1,225 additional cost every 1,000 procedures. The major determinants of ultrasound costs are the purchase cost of the ultrasound unit and the machine uses per week.
Although the ultrasound approach introduces a clinically relevant improvement of success and complication rates, it does not appear to be cost-effective.