title: Cost analysis of antibiotic-impregnated catheters in the treatment of hydrocephalus in adult patients.
abstract: OBJECTIVE
  To determine if use of antibiotic-impregnated shunt (AIS) systems to reduce cerebrospinal fluid (CSF) shunt infections in adult patients with hydrocephalus has been cost-effective at one institution.
  
  
  METHODS
  All adult patients undergoing CSF shunt insertion over a 7-year period at the Johns Hopkins Hospital were retrospectively reviewed (2004-2009). In 2006, a categorical switch to AIS catheters was made. Before 2006, standard nonimpregnated shunt catheters were used. The 1-year incidence of shunt infection was retrospectively assessed and accounting and billing records were reviewed to determine shunt infection-related medical costs for patients undergoing AIS vs non-AIS shunt surgery.
  
  
  RESULTS
  A total of 500 (250 AIS, 250 non-AIS) shunt surgeries were performed for normal-pressure hydrocephalus (NPH) (n = 378 [76%]), pseudotumor cerebri (n = 83 [17%]), and various obstructive and communicating hydrocephalus etiologies (n = 40 [8%]). The incidence of shunt infection was decreased in the AIS (1.2%) vs non-AIS (4.0%) cohorts (P = .0492. Overall, the mean cost per shunt infection was $40,371. Per 250 shunts placed, the total infection-related cost was reduced from $321,407 to $203,424 after the conversion to AIS catheters. AIS catheters were associated with direct cost savings of $47,193 per 100 shunt surgeries performed.
  
  
  CONCLUSIONS
  In a retrospective cohort study of 500 CSF shunt surgeries performed in adult patients with hydrocephalus, this institution's categorical conversion to AIS catheters was associated with a significant reduction in infection-related medical costs within the first year after surgery. Although prospective randomized cost-utility studies are needed to confirm these observations, these results suggest that AIS catheters are cost-effective in the treatment of hydrocephalus in adult patients.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: S Harrison
authors.initials: SH
authors.lastname: Farber
authors.forename: Scott L
authors.initials: SL
authors.lastname: Parker
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.forename: Daniele
authors.initials: D
authors.lastname: Rigamonti
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D015142:Baltimore; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000191:economics*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects / Q000191:economics*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004866:Equipment Contamination / Q000191:economics* / Q000517:prevention & control; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D006849:Hydrocephalus / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents