Related Experiment Videos
A cost-effectiveness analysis of endoscopic third ventriculostomy
Hugh J L Garton1, John R W Kestle, D Douglas Cochrane
1Department of Neurosurgery, University of Michigan Medical Center, Ann Arbor 48109-0338, USA. hgarton@umich.edu
Insights
Endoscopic third ventriculostomy (ETV) for pediatric hydrocephalus showed similar costs and effectiveness compared to shunts, with a 54% success rate. Further studies are needed to confirm ETV cost-effectiveness.
Area of Science:
- Neurosurgery
- Pediatric Hydrocephalus Management
- Health Economics
Background:
- Endoscopic third ventriculostomy (ETV) is a primary alternative to cerebrospinal fluid (CSF) shunts for pediatric hydrocephalus.
- Cost-effectiveness analysis is crucial for optimizing treatment strategies.
- This study compares ETV with CSF shunts in pediatric hydrocephalus management.
Purpose of the Study:
- To conduct a cost-effectiveness analysis of ETV versus CSF shunt placement in pediatric hydrocephalus.
- To evaluate resource consumption and treatment outcomes for both procedures.
Main Methods:
- Retrospective analysis of 28 pediatric patients undergoing ETV between 1989-1998.
- Patients were matched with CSF shunt recipients based on age, pathogenesis, and prior procedures.
- Hydrocephalus-related resource use and treatment-free days were assessed; costs were linked to resource use and discounted.
Main Results:
- ETV success rate was 54% (defined by reoperation); one death and one hemiparesis occurred in the ETV group.
- Shunt group had no permanent procedure-related morbidity/mortality but incurred additional resource use (6 readmissions, 8 reoperations).
- Mean costs were similar ($10,570 ETV vs. $10,922 shunt); ETV provided an additional 86 treatment-free days, but differences were not statistically significant.
Conclusions:
- In this cohort, ETV was not significantly more cost-effective or effective than shunts over a median 35-month follow-up.
- The observed success rate of 54% for ETV, coupled with additional morbidity/mortality, did not demonstrate clear advantages.
- Larger cohorts, longer follow-up, or improved ETV success rates are necessary to establish its cost-effectiveness.
Objective:
Endoscopic third ventriculostomy (ETV) is currently the principal alternative to cerebrospinal fluid shunt placement in the management of pediatric hydrocephalus. Cost-effectiveness analysis can help determine the optimal strategy for integrating these different approaches.
Methods:
All patients (n = 28) who underwent ETV at British Columbia's Children's Hospital between 1989 and 1998 were matched for age, pathogenesis, and number of previous shunt procedures, with patients treated with cerebrospinal fluid shunts. To perform a cost-effectiveness analysis, hydrocephalus-related resource consumption and outcome (determined as the number of hydrocephalus treatment-free days during follow-up) were then retrospectively identified. Cost data were linked to resource use to provide a total cost for all resources used. Costs and outcomes were discounted annually at 5% by standard economic analysis methods.
Results:
Twenty-four of 28 ETV patients had obstructive hydrocephalus. Over equivalent follow-up periods (median, 35 mo), the ETV success rate (defined by need for reoperation) was 54%. One hydrocephalus-related death and one hemiparesis occurred in the ETV group. No permanent procedure-related morbidity or mortality was seen in the shunt group. The cost/effect ratios for the two groups were similar. The additional incremental resource use by the shunt group included six readmissions and eight reoperations. ETV mean costs per patient were $10,570 +/- $7628, versus $10,922 +/- $8722 for the shunt group (Canadian dollars for the year 2000). Costs accrued more quickly for the shunt group as time passed. The additional incremental outcome benefit to the endoscopy group was 86 treatment-free days (3.07 d per patient [95% confidence interval, -7.56 to 13.70 d]). Neither of these differences was statistically significant.
Conclusion:
In this matched cohort, ETV was not significantly less costly or more effective over a median 35 months of follow-up, with a 54% initial ETV success rate, even before the additional morbidity and mortality encountered were taken into account. The time course for the accrued costs suggests that a larger cohort, longer follow-up, or higher success rates are needed to demonstrate the cost-effectiveness of this therapy.