Cost-effectiveness analysis of endoscopic third ventriculostomy

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Publication Type Journal Article
School or College School of Medicine
Department Neurosurgery
Creator Kestle, John R. W.
Other Author Garton, Hugh J. L.; Cochrane, D. Douglas; Steinbok, Paul
Title Cost-effectiveness analysis of endoscopic third ventriculostomy
Date 2002
Description 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.
Type Text
Publisher Wolters Kluwer (LWW)
Volume 51
Issue 1
First Page 69
Last Page 78
Subject Endoscopic third ventriculostomy; ETV
Subject LCSH Cerebrospinal fluid shunts; Hydrocephalus in children; Medical economics; Cost effectiveness
Language eng
Bibliographic Citation Garton, H. J. L., Kestle, J. R. W., Cochrane, D. D., & Steinbok, P. (2002). Cost-effectiveness analysis of endoscopic third ventriculostomy. Neurosurgery, 51(1), 69-78.
Rights Management (c) Wolters Kluwer (LWW) http://lww.com
Format Medium application/pdf
Format Extent 506,210 bytes
Identifier ir-main,13187
ARK ark:/87278/s66m3r0t
Setname ir_uspace
ID 703383
Reference URL https://collections.lib.utah.edu/ark:/87278/s66m3r0t
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