Ultrasound-guided central line placement as compared with standard landmark technique: Some unpleasant arithmetic for the economics of medical innovation

Objective: We perform a simple cost estimation of ultrasound guidance for the placement of central venous access, considering the US federal reimbursement for ultrasound guidance of central line placement to the federal reimbursement for treating the complication of pneumothorax. Methods: We utilize national statistics on the number of central lines placed annually to determine the cost savings incurred if all central lines placed in the United States were placed with ultrasound guidance. Results: The initial "cost" of placing central lines was found to be 390,780,000 to 651,300,000 dollars per year by the landmark technique, as compared with 494,820,000 to 824,700,000 dollars per year by ultrasound guidance. Conclusions: The cost of ultrasound guidance was not mitigated by its reduction in the cost of treating pneumothoraces.