Ultrasound-guided umbilical venous catheterisation: A cost-effectiveness analysis

Introduction: Although the use of ultrasound for the insertion of central catheters has proven to be cost-effective in adults, it is not known if this is the case in the neonatal population. This study compared the cost-effectiveness of ultrasound-guided umbilical venous catheterisation with conventional catheterisation in a neonatal intensive care unit of a Public University Hospital. Patients and methods: A retrospective observational study was conducted on newborns that required an umbilical venous catheter before completing their first 24 hours of extra-uterine life. Two retrospective cohorts were formed, including one with ultrasound-guided catheterisation and the other with conventional catheterisation. The effectiveness was measured using 2 variables: placement of ideal position and insertion without complications. The cost of human and material resources (consumable and non-consumable), the cost-effectiveness ratio, and the incremental cost-effectiveness ratio were estimated, as well as carrying out a sensitivity analysis. Results: Catheter obstruction was more frequent in guided catheterisation than in conventional catheterisation (7.7% vs. 0%, p = .04) and catheter dysfunction was higher in the latter (79% vs. 3.8%, p < .0001). The cost-effectiveness ratio of the guided catheterisation was (sic)153.9, and (sic)484.6 for the conventional one. The incremental cost-effectiveness ratio was (sic)45.5. The sensitivity analysis showed a (sic)2.6 increase in the cost-effectiveness ratio of the guided catheterisation and (sic)47 in the conventional one. Conclusions: The use of ultrasound to guide umbilical catheterisation is more efficient than conventional catheterisation since, despite using more economic resources, it offers greater effectiveness. (C) 2019 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L.U.