Cost effectiveness of tunneled double lumen to non-tunnel double lumen dialysis catheters.

Objectives: To ascertain the cost-effectiveness of tunneled catheters to non-tunneled catheter in dialysis patients of a tertiary care hospital. Study Design: Retrospective cross-sectional study. Study Design: Department of Nephrology, Pak Emirates Military Hospital Rawalpindi. Period: Jan 2016 to Jan 2019. Material & Methods: The sample population comprised of 500 patients, being divided into two groups and followed over a period of 03 yrs. Group A had tunneled double lumen and group B had non tunneled double lumen. Dialysis was started on the same day in both groups. Both groups were compared in terms of cost effectiveness. Cost effectiveness included price of catheter, procedure cost, treatment of infection (if any), and change of catheter in case of catheter malfunction. The amount spent on each patient was added and then an average was calculated. Results: Out of 600 patients, 300 were in group A and 300 patients were in group B. The two groups were analogous in gender (male: 52.8% vs 57.8%, p=0.35)age (41 years vs 49 yrs, p=0.71) hypertension and diabetes as the main causes of ESRD (51% vs 39%, p=0.08 and 32% vs 34%, p=0.38, respectively). Total incurred cost of tunneled double lumen was Rs.19000.00, with average infection free patency time being three months during which Arteriovenous fistula formed. In comparison, non-tunneled double lumen in 300 patients, average cost incurred was Rs.30000.00 including cost incurred on treating sepsis and in two –three insertions in few cases . There was no procedure related mortality. Conclusion: The cost-effectiveness of Tunneled double lumen catheters and clinical benefit of reduction in patency failures and also access related infections make them the first choice for dialysis patients in majority of dialysis centers of our country but large randomized control trials needed as the sample size quite less to detect a difference from the newer agents.