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Do adjustable shunt valves pressure our budget? A retrospective analysis of 541 implanted Codman Hakim programmable
1Department of Clinical Neuroscience, Division of Neurosurgery, Lund University Hospital, Lund, Sweden.
Insights
The Codman Hakim Programmable Valve (CHPV) offers cost savings by avoiding surgical interventions. Adjusting the programmable valve
Area of Science:
- Neurosurgery
- Medical Devices
- Health Economics
Background:
- Hydrocephalus management often requires cerebrospinal fluid (CSF) shunting.
- Programmable valves allow non-invasive adjustment of CSF outflow resistance.
- Codman Hakim Programmable Valves (CHPV) were evaluated for cost-effectiveness.
Observation:
- A retrospective study analyzed 541 CHPV implantations in 477 patients over 6 years.
- The study compared the cost of CHPV against non-programmable valves.
- Valve adjustments and potential surgical interventions were key metrics.
Findings:
- The cost-effectiveness analysis indicated that CHPV breaks even financially if 105.8 valve exchanges are avoided.
- In 107 instances, valve adjustments of 50 mmH2O or more were performed.
- These adjustments, if equated to valve exchanges, were sufficient to achieve financial breakeven.
Implications:
- The higher initial cost of CHPV is offset by the ability to non-invasively adjust the opening pressure.
- This reduces the need for repeat surgeries, improving patient outcomes and lowering overall healthcare costs.
- Programmable valves represent a potentially more economical and clinically advantageous option for hydrocephalus management.
Abstract:
Based on a retrospective study in which a total of 541 Codman Hakim Programmable Valves (CHPV) were implanted in 477 patients over a 6-year period, this cost analysis was performed. By using a valve with an adjustable opening pressure, valve exchange to alter the opening pressure and surgical evacuation of subdural haematomas and hygromas can be avoided. Dividing the added cost for using the CHPV by the cost of implanting a non-programmable Hakim valve results in 105.8 valve exchanges, which would have had to be avoided to break even financially. On 107 occasions a valve was adjusted by a magnitude of 50 mmH2O or more. This, if an adjustment of that magnitude is said to correspond to a valve exchange, is sufficient to break even. The analysis suggests that the extra cost of the valve is outweighed by the ability to adjust the opening pressure setting non-invasively.
