부산대학교 도서관

Background and Purpose: Implantable port-catheter system (Port-A) is the most commonly used intravascular device on oncology patients. However, Port-A associated bloodstream infection (PABSI) is an important issue of caring oncology patient. How to prevent Port-A associated bloodstream infection (PABSI) is the challenge of oncologist. Antiseptic solution on port-A skin care is one method of preventing PABSI. The purpose of this study was to use cost effectiveness analysis to evaluate the number of infections and associated costs using Chlorhexidine and Povidone Iodine. Study Methods: A prospective study of evaluation port-A bloodstream infection between using Chlorhexidine and Povidone Iodine on port-A skin dressing were carried out from Oct. 2009 to Feb. 2012. The view point of this cost effectiveness analysis is based on the hospital. The cost analyzed included total medical charge and infection charge within study period and used cost to charge ratio to correct the charge data and to evaluate incremental cost effectiveness ratio and net benefit. Results The average total medical cost of the oncology patient during the study period was NTD 360,675.21. The average total medical cost of the oncology patient with PABSI during the study period was NTD 564,287.33, which is significantly higher than that of patients without PABSI at NTD 331,112,99. The average total medical cost during PABSI period was NTD 210,101.61. The factors associated with medical cost of PABSI were cancer type, total length of stay, use of intensive care unit and infection type. The incremental cost effectiveness ratio of preventing one patient with Port-A associated bloodstream infection by using Chlorhexidine on port-A skin dressing was NTD 78057.6. Net benefit of using Chlorhexidine to replace Povidone iodine can save the hospital NTD 1,230,452.47 annually. Recommendations The hospital can save the cost and get effectiveness by using Chlorhexidine on port-A skin care after oncology procedures were included the Diagnosis related groups (DRGs). In order to improve the life quality of oncology patient and decrease bloodstream infection, future reserachers may consider using quality-adjusted life year (QALY) to conduct cost utility analyses.