Cost analysis of antibiotic-impregnated catheters in the treatment of hydrocephalus in adult patients.

Abstract

OBJECTIVE:

To determine if use of antibiotic-impregnated shunt (AIS) systems to reduce cerebrospinal fluid (CSF) shunt infections in adult patients with hydrocephalus has been cost-effective at one institution.

METHODS:

All adult patients undergoing CSF shunt insertion over a 7-year period at the Johns Hopkins Hospital were retrospectively reviewed (2004-2009). In 2006, a categorical switch to AIS catheters was made. Before 2006, standard nonimpregnated shunt catheters were used. The 1-year incidence of shunt infection was retrospectively assessed and accounting and billing records were reviewed to determine shunt infection-related medical costs for patients undergoing AIS vs non-AIS shunt surgery.

RESULTS:

A total of 500 (250 AIS, 250 non-AIS) shunt surgeries were performed for normal-pressure hydrocephalus (NPH) (n = 378 [76%]), pseudotumor cerebri (n = 83 [17%]), and various obstructive and communicating hydrocephalus etiologies (n = 40 [8%]). The incidence of shunt infection was decreased in the AIS (1.2%) vs non-AIS (4.0%) cohorts (P = .0492. Overall, the mean cost per shunt infection was $40,371. Per 250 shunts placed, the total infection-related cost was reduced from $321,407 to $203,424 after the conversion to AIS catheters. AIS catheters were associated with direct cost savings of $47,193 per 100 shunt surgeries performed.

CONCLUSIONS:

In a retrospective cohort study of 500 CSF shunt surgeries performed in adult patients with hydrocephalus, this institution's categorical conversion to AIS catheters was associated with a significant reduction in infection-related medical costs within the first year after surgery. Although prospective randomized cost-utility studies are needed to confirm these observations, these results suggest that AIS catheters are cost-effective in the treatment of hydrocephalus in adult patients.

• Authors: S Harrison Farber, Scott L Parker, Owoicho Adogwa, Daniele Rigamonti, Matthew J McGirt
• Journal: World neurosurgery (World Neurosurg) 2010 Oct-Nov Vol. 74 Issue 4-5 Pg. 528-31 ISSN: 1878-8769 [Electronic] United States
• PMID: 21492607 (Publication Type: Journal Article)
• Copyright: Copyright © 2010 Elsevier Inc. All rights reserved.

Chemical References

• Anti-Bacterial Agents

Topics

• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (economics, therapeutic use)
• Baltimore
• Catheters, Indwelling (adverse effects, economics)
• Cerebrospinal Fluid Shunts (adverse effects, economics)
• Cohort Studies
• Cost-Benefit Analysis
• Equipment Contamination (economics, prevention & control)
• Female
• Hospitals, Teaching
• Humans
• Hydrocephalus (physiopathology, surgery)
• Male
• Middle Aged
• Retrospective Studies
• Surgical Wound Infection (drug therapy, epidemiology, prevention & control)
• Young Adult