Antibiotic Impregnated External Ventricular Drains: Meta and Cost Analysis

Area of Science:

• Neurosurgery
• Infectious Disease Prevention
• Health Economics

Background:

• Ventriculostomy-associated infections (VAI) pose a significant risk to patients requiring external ventricular drains (EVDs).
• The efficacy and cost-effectiveness of antibiotic-impregnated EVDs (AI-EVDs) in preventing VAI remain areas of active investigation.

Purpose of the Study:

• To evaluate the effectiveness of AI-EVDs in preventing VAI.
• To assess the cost-effectiveness of utilizing AI-EVDs compared to standard EVDs.

Main Methods:

• A systematic literature search identified randomized controlled trials and observational cohort studies comparing AI-EVDs with non-impregnated controls.
• A random effects meta-analysis was conducted on the pooled data.
• Institutional historical data were used to calculate incremental costs and VAI-associated hospital expenses.

Main Results:

• The meta-analysis included 3 RCTs and 5 observational studies, demonstrating a significant protective effect of AI-EVDs against VAI (Risk Ratio = 0.31).
• The number needed to treat (NNT) with AI-EVDs to prevent one VAI was 19.
• AI-EVDs are projected to save an estimated $28,100 per NNT, with potential annual savings ranging from $109,292 to $278,577 for hospitals using 150 annually.

Conclusions:

• AI-EVDs offer a statistically significant reduction in VAI.
• The use of AI-EVDs is associated with considerable cost savings for healthcare institutions.
• While current data support the efficacy and cost-effectiveness of AI-EVDs, further research is warranted due to limited available data.