title: Antibiotic Impregnated External Ventricular Drains: Meta and Cost Analysis.
abstract: OBJECTIVE
  To determine whether antibiotic impregnated external ventricular drains (AI-EVDs) are effective in preventing ventriculostomy associated infection (VAI), and to examine their cost effectiveness.
  
  
  METHODS
  A comprehensive literature search was performed for published data through May 2014, including randomized controlled trials and observational cohort studies comparing AI-EVDs with nonimpregnated controls. A meta-analysis of included studies was performed using a random effects model. Historical data at the authors' institution were used to estimate both the incremental price of AI-EVDs and the hospital expenses associated with VAI.
  
  
  RESULTS
  Three randomized controlled trials and 5 observational studies met inclusion criteria. The analysis demonstrated a statistically significant protective effect of AI-EVDs against VAI (risk ratio = 0.31 [0.15-0.64]; P = 0.002), although there was significant heterogeneity (χ(2) = 18.08; P = 0.01; I(2) = 61%). The number of AI-EVDs needed to prevent one infection (Number needed to treat [NNT]) was 19. Based on $100 as the incremental price, and $30,000 as the estimated expense of one episode of VAI, AI-EVDs would result in an overall savings estimate of $28,100 (range, $26,400-$28,500) per NNT. If a hospital places 150 AI-EVDs annually, savings could range from $109,292 to $278,577 per year.
  
  
  CONCLUSIONS
  Meta-analysis demonstrated a significant protective benefit of AI-EVDs against VAI, and this benefit is likely associated with cost savings. However, current data on AI-EVDs are limited, and overall hospital costs will vary among institutions. Although both the efficacy and cost effectiveness of AI-EVDs are supported by this analysis, further study of AI-EVDs is clearly warranted.
authors.affiliation: Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire, USA. Electronic address: Brandon.K.Root@hitchcock.org.
authors.forename: Brandon K
authors.initials: BK
authors.lastname: Root
authors.affiliation: Geisel School of Medicine at Dartmouth, One Rope Ferry Road, Hanover, New Hampshire, USA.
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Barrena
authors.affiliation: Geisel School of Medicine at Dartmouth, One Rope Ferry Road, Hanover, New Hampshire, USA.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Mackenzie
authors.affiliation: Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire, USA; Geisel School of Medicine at Dartmouth, One Rope Ferry Road, Hanover, New Hampshire, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Bauer
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D057785:Catheters / Q000191:economics; D002552:Cerebral Ventricles / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004322:Drainage / Q000191:economics* / Q000295:instrumentation*; D017721:Hospital Costs; D006801:Humans; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic-impregnated; External ventricular drain; Infection; Meta-analysis; Ventriculitis