Improving Appropriate Use of Peripherally Inserted Central Catheters Through a Statewide Collaborative Hospital Initiative: A Cost-Effectiveness Analysis

Background: Quality improvement (QI) programs require significant financial investment. We evaluated the cost-effectiveness of a physician-led, performance-incentivized, QI intervention that increased appropriate peripherally inserted central venous catheter (PICC) use. Methods: We used an economic evaluation from a healthcare sector perspective. Implementation costs included incentive payments to hospitals and costs for data abstractors and the coordinating center. Effectiveness was calculated from propensity score matched observations across two time periods for complications (i.e., venous thromboembolism [VTE], central line-associated blood stream infection [CLABSI], and catheter occlusion): pre-intervention period (January 2015 through December 2016) and intervention period (January 2017 through December 2021). Cost-effectiveness was presented as the cost-offset per averted complication, reflecting the healthcare costs avoided due to having lower complication rates. Results: Across 35 hospitals, we sampled 17,418 PICCs placed pre-intervention and 26,004 placed during the intervention period. PICC complications decreased significantly following the intervention. CLABSIs decreased from 2.1% to 1.5%, VTEs from 3.2% to 2.3%, and catheter occlusions from 10.8% to 7.0% (all p < 0.01). Estimated number of complications prevented included 871 CLABSIs, 2,535 VTEs, and 8,743 catheter occlusions. Project implementation costs were $31.8 million, and the cost-offset related to avoided complications was $64.4 million. Each participating hospital averaged $932,073 in cost-offset over 7 years, and the average cost-offset per complication averted was $2,614 (95% confidence interval: $2,314, $3,003). Conclusion: A large-scale, multi-hospital QI initiative to improve appropriate PICC use yielded substantial return on investment from cost-offset of prevented complications.