Can you put a price tag on a person’s quality of life? I’m sure many of us in the oncology field have asked ourselves this question. Oncology is a world full of expenses: drugs, procedures, and surgeries, to name a few. However, I find myself asking that question more frequently since the pulmonologists at my facility have started placing indwelling PleurX catheters in patients with recurrent malignant pleural effusions.
For many of you, the PleurX catheter may not be a new procedure. They have, in fact, been utilized by some centers for approximately a decade. I work in a smaller community setting, where the PleurX catheter was more recently introduced about two years ago, when a new, younger pulmonologist who had been using them in residency joined the existing group at our facility.
For those who are not familiar with the PleurX, it is a small tunneled catheter with one end placed in the pleural space while the other end remains outside the chest wall under a dressing to be drained as needed. A PleurX catheter can also be utilized for malignant ascites, but as a lung nurse navigator, my focus has been on stage IV lung cancer patients.
For those patients whose desire is not to spend their final days frequently traveling to the hospital and having the pleural fluid drained from their chest by a thoracentesis, or worse, having a chest tube placed, the PleurX catheter can help patients to avoid all of that. Since patients are able to remain at home with this kind of catheter in place, family members and/or caregivers are taught to drain the PleurX catheter, which helps to increase the quality of life for the patient battling end-stage cancer.
Based on this information alone, who wouldn’t say, “Sure, sign me up!"? However, there is another side of the story. The PleurX catheter drainage kits and bottles do not come with a small price tag. The compassionate nurse inside me says, “Who cares about the cost?” But I’ve been a nurse long enough to know the other side matters as well. Management worries about the overall cost to the hospital. The physicians worry about the overall cost to healthcare. The patients and families worry about the overall cost coming out of their pocket. These are all legitimate concerns.
Most insurance carriers do cover at least a portion of the cost (if not more), but for some people that may still mean pretty steep co-pays. The price I have heard quoted most frequently is around $800 per drainage kit/bottle. You can imagine, even with insurance, for patients who are draining their catheter every day or even every other day the cost can accumulate rather quickly. In addition, the question of who is responsible for the cost gets very sticky, depending on whether the patient has private insurance or Medicaid/Medicare. Also factoring into the mix is whether their care will involve home health care, hospice, or a long-term care nursing facility.
I would highly recommend that if you are ever dealing with an issue of supplies or coverage for a patient with a PleurX catheter, call Edgepark Medical. It is a contracted company with CareFusion to assure patients that they have what they need when they need it. It does a fabulous job of accomplishing that goal. It also offers a financial assistance program.
A PleurX catheter is certainly not the answer for all patients with recurrent malignant pleural effusions. For those who are good candidates for the catheter, in my experience, it has made a world of difference. I have heard a son tell me how much it meant to his father to be able to remain living independently until his final days of life. I've also heard a wife express how much her family cherished being able to have her husband home to die surrounded by his loved ones, instead of in the hospital. The compassionate nurse in me asks, “Can you really put a price tag on quality of life?"
Are you familiar with PleurX catheters? What has your experience with them been? Would you say that they are worth the cost?