title: Transverse sinus stenting for pseudotumor cerebri: a cost comparison with CSF shunting.
abstract: OBJECTIVE
  Transverse sinus venous stent placement has been shown to lower intracranial pressure in patients with venogenic pseudotumor cerebri and to reverse, or at least stabilize, its symptoms and signs. There have been no studies comparing the cost of venous stenting with the time-honored treatment for pseudotumor cerebri-CSF shunting. The purpose of this study was to compare the cost of trasverse sinus stenting versus CSF shunting for the treatment of pseudotumor cerebri.
  
  
  METHODS
  This work was a retrospective cost analysis of individual resource use in 86 adults who were stented for pseudotumor cerebri during a 12-year period compared with resource use in 110 children who were shunted for hydrocephalus during a 3-year period.
  
  
  RESULTS
  There was no significant difference between the cost of inserting an initial venous stent ($13,863 ± 4890) versus inserting an initial CSF shunt ($15,797 ± 5442) (P = .6337) or between inserting an additional venous stent ($9421 ± 69) versus revising a CSF shunt ($10,470 ± 1245) (P = .4996). There were far fewer additional venous stent insertions per patient than there were subsequent CSF shunt revisions; 87% of stents placed required just 1 stent procedure, whereas only 45% of shunts required 1 shunt procedure. The main cause of the cost difference was the need for repeated revisions of the shunts, especially when they became infected-24 instances of a total 143 shunt procedures (16.8%) at an average cost of $84,729, approximately 5 times the cost of an initial shunt insertion.
  
  
  CONCLUSIONS
  Venous stenting costs significantly less per 100 procedures than does CSF shunting, due largely to the high cost of treating shunt infections and the need for repeated shunt revisions.
authors.affiliation: From the Departments of Neurology (R.A., G.M.H.).
authors.forename: R M
authors.initials: RM
authors.lastname: Ahmed
authors.affiliation: Époque Consulting (F.Z.), Sydney, Australia.
authors.forename: F
authors.initials: F
authors.lastname: Zmudzki
authors.affiliation: Radiology (G.P.), Royal Prince Alfred Hospital, Sydney Australia.
authors.forename: G D
authors.initials: GD
authors.lastname: Parker
authors.affiliation: TY Nelson Department of Neurology and Neurosurgery (B.O.), Children's Hospital at Westmead, Sydney, AustraliaDiscipline of Pediatrics and Child Health, and Surgery (B.O.), University of Sydney, Sydney, Australia.
authors.forename: B K
authors.initials: BK
authors.lastname: Owler
authors.affiliation: From the Departments of Neurology (R.A., G.M.H.) gmh@icn.usyd.edu.au.
authors.forename: G M
authors.initials: GM
authors.lastname: Halmagyi
mesh_terms: D000328:Adult; D001315:Australia; D001807:Blood Vessel Prosthesis / Q000191:economics*; D002557:Cerebrospinal Fluid Shunts / Q000191:economics*; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011559:Pseudotumor Cerebri / Q000191:economics* / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents / Q000191:economics*; D054064:Transverse Sinuses / Q000601:surgery*; D016896:Treatment Outcome