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.
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: Michael D Jenkinson; Carrol Gamble; John C Hartley; Helen Hickey; Dyfrig Hughes; Michaela Blundell; Michael J Griffiths; Tom Solomon; Conor L Mallucci Journal: Trials Date: 2014-01-03 Impact factor: 2.279
Authors: Conor L Mallucci; Michael D Jenkinson; Elizabeth J Conroy; John C Hartley; Michaela Brown; Tracy Moitt; Joanne Dalton; Tom Kearns; Michael J Griffiths; Giovanna Culeddu; Tom Solomon; Dyfrig Hughes; Carrol Gamble Journal: Health Technol Assess Date: 2020-03 Impact factor: 4.014
Authors: Conor L Mallucci; Michael D Jenkinson; Elizabeth J Conroy; John C Hartley; Michaela Brown; Joanne Dalton; Tom Kearns; Tracy Moitt; Michael J Griffiths; Giovanna Culeddu; Tom Solomon; Dyfrig Hughes; Carrol Gamble Journal: Lancet Date: 2019-09-12 Impact factor: 79.321