The relative cost-effectiveness of atraumatic needles compared to conventional needles in diagnostic lumbar punctures

Clinical evidence indicates that atraumatic needles (ATNs) versus conventional needles (CNs) reduce diagnostic lumbar puncture (DLP) complications. Despite this, the use of CNs in DLP remains widespread. This analysis estimates the cost-effectiveness of ATNs versus CNs in DLP.

We constructed a model mapping DLP patient pathways and complications (limited to PDPH events and PDPH-related hospitalisations/epidural blood patches (EBP)). Model development was carried out in consultation with local clinical experts. Published data informed clinical data inputs (DLP characteristics and likelihood of PDPH) and resource estimates. Costs of PDPH management were estimated from UK NHS Reference Costs. Costs of LP were limited to needle costs. Model outputs included total PDPH, total costs, cost per PDPH avoided and numbers need to treat (NNT) to avoid one case of PDPH. Extensive one-way sensitivity analyses were conducted.

Based on 100 patients undergoing DLP with CN (ATN), we estimated 31 (12) cases of PDPH with 7 (3) patients requiring EBP with total costs estimated at £9,469 (£4,257) i.e. 19 fewer cases of PDPH with ATN at a cost saving of £5,212. NNT to avoid one case of PDPH (hospitalised PDPH) was estimated at 5 (13). Clinical benefits and cost savings were robust to plausible input changes.

Our model findings support an economic case for use of ATN in preference to CN in DLP, with improved outcomes achieved at a cost saving. Local data collection is recommended but is not expected to change the model findings.