No significant cost savings are achieved by using a recombinant tissue plasminogen activator (rt-PA) and twice-weekly heparin as a locking solution for dialysis catheters compared to heparin alone (3 times per week), according to a study published online ahead of print in the Journal of the American Society of Nephrology.
Braden J. Manns, MD, from the University of Calgary in Canada, and colleagues collected detailed costs within a randomized controlled trial comparing an rt-PA/heparin locking solution to heparin alone. The authors sought to determine how choice of locking solution would affect overall health care costs, including the cost of locking solutions and all other relevant medical costs over the course of the six-month trial.
The researchers found that the cost of the locking solution was higher in patients receiving rt-PA/heparin, but this was partially offset by lower costs for managing complications. The difference in unadjusted mean cost for managing patients with rt-PA/heparin versus heparin alone was a non-significant $323 (Canadian).
Extrapolating the costs over a 1-year time horizon, assuming ongoing rt-PA effectiveness, the overall costs of the strategies were similar. Plausible variation in the frequency and cost of managing patients with catheter-related bacteremia, and whether the benefit of rt-PA on catheter-related bacteremia was maintained in the long term, led to sensitivity in the findings.
“In summary, we noted no significant difference in the mean overall cost of an rt-PA/heparin strategy as a locking solution for catheters compared with thrice-weekly heparin,” the authors concluded.