Venous sinus stenting versus ventriculoperitoneal shunting: Comparing perioperative costs for idiopathic intracranial hypertension

IntroductionVenous sinus stenting (VSS) is an effective, less invasive alternative to ventriculoperitoneal shunting (VPS) for idiopathic intracranial hypertension (IIH). While efficacy is comparable, with some evidence favoring VSS for headache control, perioperative costs remain under-characterized due to reliance on reimbursement rates rather than actual expenditures.ObjectiveTo compare the perioperative cost of elective VSS and VPS for IIH, including outpatient workup and follow-up costs, using detailed institutional cost data.MethodsWe retrospectively analyzed IIH patients treated with VSS or VPS from 2017 to 2022 at a single center. All IIH-related costs were captured from 90 days pre-op through 90 days post-op and categorized as fixed (e.g. OR staff) or variable (e.g. supplies). Patients with fulminant IIH or unrelated elective procedures were excluded. Comparisons used Mann-Whitney U and Fisher's exact tests (p < 0.05).ResultsForty-three patients met criteria (VSS n = 19, VPS n = 24), with no significant differences in age, body mass index, papilledema, opening pressure, or pulsatile tinnitus. Preoperative costs were significantly higher for VSS (median $14,951 [IQR 10,835-16,043] vs $4767 [1, 293, 410-11]; p = 0.008), including both variable (p = 0.008) and fixed (p = 0.015) cost components. Surgical admission costs were similar between groups (p = 0.403), as were postoperative costs (p = 0.509). Total 180-day costs remained significantly higher for VSS ($38,576 [011-43, 36, 590]) compared to VPS ($31,509 [25, 208-37, 342]; p = 0.001).ConclusionVSS incurs higher preoperative and total costs than VPS. Streamlining VSS workup may improve value. Further studies should assess downstream cost avoidance to determine long-term cost-effectiveness.