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Comparative Effectiveness of Surgical Treatments for Pediatric Hydrocephalus
I-Wen Pan1, Dominic A Harris1, Thomas G Luerssen1
1Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
Insights
Endoscopic third ventriculostomy (ETV) and cerebrospinal fluid shunts are common pediatric hydrocephalus treatments. ETV showed higher failure rates than shunts, particularly in infants under one year old.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Health Services Research
Background:
- Pediatric hydrocephalus presents a significant healthcare challenge in the US.
- Surgical interventions are the primary treatment modality for this condition.
Purpose of the Study:
- To compare the effectiveness of endoscopic third ventriculostomy (ETV) versus cerebrospinal fluid (CSF) shunt placement for pediatric hydrocephalus.
- Utilize propensity score matching on a large administrative claims database for comparative analysis.
Main Methods:
- Analysis of the MarketScan® database (2003-2011) including patients 19 years or younger.
- Defined surgery failure as requiring subsequent surgical treatment for hydrocephalus.
- Employed propensity score matching, Kaplan-Meier survival curves, log-rank tests, and Cox proportional-hazard models.
Main Results:
- Of 3231 eligible cases, propensity score matching created 455 balanced pairs.
- ETV demonstrated a higher likelihood of surgery failure compared to shunts (relative risk = 1.4, P = .011).
- Infants under 1 year old experienced lower ETV success rates than shunts (P = .009), with no significant difference in older children.
Conclusions:
- Overall, no significant difference in time to failure between ETV and shunt was observed.
- A notable exception exists for infants under one year of age, where shunts appear more effective than ETV.
Background:
Pediatric hydrocephalus represents a high health care burden in the United States (US). Surgery is the mainstay of treatment.
Objective:
To perform a comparative effectiveness analysis for endoscopic third ventriculostomy (ETV) and cerebrospinal fluid shunt placement in pediatric hydrocephalus patients in the US using a large administrative claims database through the application of propensity scores matching.
Methods:
The MarketScan® database (Truven Health Analytics, Atlanta, Georgia) 2003 to 2011 was used. Patients 19 yr or younger at first occurrence of ETV or shunt during the study period were included. The study outcome, surgery failure, was defined as further surgical treatment for hydrocephalus subsequent to initial ETV or shunt procedure. Age, etiology of hydrocephalus, and history of shunt were used to create matched samples for the ETV and shunt cohorts. Kaplan-Meier survival curves, stratified log-rank test, and Cox proportional-hazard models were used to analyze samples.
Results:
There were 3231 eligible cases (478 ETV; 2753 shunt). Propensity scores matching produced 455 balanced pairs. For matched samples, 326 of 455 (72%) pairs were concordant, while 129 pairs were discordant in surgery outcomes within 3 mo. Among discordant pairs, ETV patients were more likely to experience surgery failure compared to patients receiving shunt (relative risk = 1.4, P value = .011). Furthermore, patients' age < 1 yr had lower ETV success rates than those with shunt (P value = .009). No similar pattern was found in patients' age ≥ 1 yr.
Conclusion:
There was no significant effect on time to failure between patients undergoing ETV and shunt, except in infants' age <1 yr.
