E-Mail karger@karger.com Editorial Comment Respiration 2013;86:181–182 DOI: 10.1159/000354184 Indwelling Pleural Catheters for Ambulatory Out-Patient Care: A Price Worth Paying? Rahul Bhatnagar Nick Maskell Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol, UK IPCs have repeatedly been shown to be safe and well tolerated, with low levels of infection and high rates of symptomatic relief [5]. They also demonstrably reduce in- patient stays in both the long and short term [6, 7]. Origi- nally used as a fall-back device in cases of failed pleurode- sis or trapped lung, there is a growing consensus that they can be offered to patients as a first-line treatment [7], ef- fectively trading the idea of pleurodesis being the priority for an acceptance that it is occasionally in a patient’s best interests to simply manage symptoms. In this issue of Respiration, Boshuizen et al. [8] report a series of 50 IPCs, most of which were inserted as pri- mary therapy for MPE. Echoing what has been reported before, their cohort demonstrates a significant reduction in both repeat pleural procedures and inpatient stay when compared to talc pleurodesis, alongside low rates of com- plications. Perhaps the most novel aspect of the study is the recording of the direct costs of IPC use in a European country – data which may help to more accurately deter- mine the long-term cost-effectiveness of IPCs. The lim- ited work in this area has consistently been based on costs and models of treatment from the USA [9–11], with flaws demonstrable in all studies. This current report also notes that there can be significant variability between the direct costs of using an IPC depending on disease subtype and cancer treatment success, highlighting once more the het- erogeneity of survival amongst MPE patients and perhaps The development of the indwelling pleural catheter (IPC) has revolutionized the management of recurrent pleural effusions, and, in particular, those caused by ma- lignancy. Apart from cases of mesothelioma, malignant pleural effusions (MPEs), by definition, represent meta- static disease and are hence associated with severely re- duced survival times and limited curative options. Al- though survival can extend beyond 1 year, the majority of studies show that an average of 4–6 months can be ex- pected [1], with patient mortality sometimes being mea- sured in weeks from first diagnosis [2] depending on the tumor subgroup. In the face of such aggressive disease, even a short pe- riod of hospitalization can immeasurably disrupt a pa- tient’s remaining quality of life, potentially invoking a sense of helplessness and disempowerment. With this in mind, it may be seen as frustrating that the traditional management options for MPE have been largely limited to inpatient procedures. Chemical pleurodesis, usually with sterile talc, attempts to prevent fluid recurrence over the medium- to long-term. In spite of being successful in the majority of cases [3], this approach often requires pa- tients to remain in hospital for many days [4]. Continual and global increases in both direct costs and the burden on hospital resources mean that admission avoidance for MPE can lead to significant benefit for both patients and healthcare providers. Published online: September 5, 2013 Dr. Nick Maskell Academic Respiratory Unit, School of Clinical Sciences, University of Bristol Learning and Research Building, Southmead Hospital Bristol BS10 5NB (UK) E-Mail Nick.Maskell  @  bristol.ac.uk © 2013 S. Karger AG, Basel 0025–7931/13/0863–0181$38.00/0 www.karger.com/res Downloaded by: Frenchay Hospital 82.33.242.34 - 2/6/2015 3:31:24 PM