title: Cost savings associated with antibiotic-impregnated shunt catheters in the treatment of adult and pediatric hydrocephalus.
abstract: BACKGROUND
  Cerebrospinal fluid (CSF) shunt infection is a major cause of morbidity and mortality in the treatment of hydrocephalus and is associated with significant medical cost. Several studies have demonstrated the efficacy of antibiotic-impregnated (AI) shunt catheters in reducing CSF shunt infection; however, providers remain reluctant to adopt AI catheters into practice because of the increased upfront cost. The objective of this study was to determine if the use of AI catheters provided cost savings in a large nationwide database.
  
  
  METHODS
  Hospital discharge and billing records from the Premier Perspective Database from 2003-2009 were retrospectively reviewed to identify all adult and pediatric patients undergoing de novo ventricular shunt placement. The incidence of shunt infection within 1 year of implantation was determined. Shunt infection-related cost was defined as all inpatient billing costs incurred during hospitalization for treatment of shunt infection.
  
  
  RESULTS
  In 287 U.S. hospitals, 10,819 adult (AI catheters, 963; standard catheters, 9856) and 1770 pediatric (AI catheters, 229; standard catheters, 1541) patients underwent ventricular shunt placement. AI catheters were associated with significant reduction in infection for both adult (2.2% vs. 3.6%, P = 0.02) and pediatric (2.6% vs. 7.1%, P < 0.01) patients. Total infection-related costs were $17,371,320 ($45,714 ± $49,745 per shunt infection) for adult patients and $6,508,064 ($56,104 ± $65,746 per shunt infection) for pediatric patients. Infection-related cost per 100 de novo shunts placed was $120,534 for AI catheters and $162,659 for standard catheters in adult patients and $165,087 for AI catheters and $395,477 for standard catheters in pediatric patients.
  
  
  CONCLUSIONS
  In analysis of this large, nationwide database, AI catheters were found to be associated with a significant reduction in infection incidence, resulting in tremendous cost savings. AI catheters were associated with a cost savings of $42,125 and $230,390 per 100 de novo shunts placed in adult and pediatric patients, respectively.
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Parker
authors.affiliation: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.affiliation: DePuy Orthopaedics, Warsaw, Indiana, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Murphy
authors.affiliation: Codman & Shurtleff, Inc, Raynham, Massachusetts, USA. Electronic address: jmegeri1@its.jnj.com.
authors.forename: J Thomas
authors.initials: JT
authors.lastname: Megerian
authors.affiliation: DePuy Orthopaedics, Warsaw, Indiana, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Stout
authors.affiliation: Codman & Shurtleff, Inc, Raynham, Massachusetts, USA.
authors.forename: Luella
authors.initials: L
authors.lastname: Engelhart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000191:economics* / Q000517:prevention & control*; D057785:Catheters; D002557:Cerebrospinal Fluid Shunts / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D016208:Databases, Factual; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000191:economics* / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic-impregnated; Hydrocephalus; Infection; Shunt