Indwelling Pleural Catheters Versus Chemical Pleurodesis for Managing Malignant Pleural Effusions: A Population-Based Study and Real-World Economic Evaluation Protocol

Abstract

There is limited data on mortality, health service use and costs following treatment of malignant pleural effusions (MPE) in the real-world setting. We performed a retrospective population-based study using health administrative data of adults with indwelling pleural catheter (IPC) insertion (n=4,574) or pleurodesis (n=1,235) for MPE between 2015 to 2019. Inverse probability of treatment weighting using the propensity score was performed to adjust for baseline characteristic imbalances. After weighting to balance on baseline characteristics, there was no significant difference in post-procedure mortality between individuals receiving IPCs and pleurodesis, with IPCs inserted significantly later after an initial cancer diagnosis. IPCs with home nursing drainage were associated with reduced subsequent health resource use and healthcare costs compared to pleurodesis. A protocol was developed for a future economic evaluation to compare the cost-effectiveness of the procedures. This thesis provides the foundation for further research to help optimize the treatment of individuals with MPEs.