Endoscopic third ventriculostomy has no higher costs than ventriculoperitoneal shunt

Lima, Benicio Oton de; Pratesi, Riccardo

doi:10.1590/0004-282x20140070

Cited by 15 publications

(9 citation statements)

References 27 publications

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“…This finding is consistent with other studies in the published literature. [ 3 , 10 , 15 , 20 ] This is likely due to the nature of the procedure itself. While VPS involves the use of a foreign body, which is prone to infection and blockage, ETV does not.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic third ventriculostomy versus ventriculoperitoneal shunt insertion for the management of pediatric hydrocephalus in African centers – A systematic review and meta-analysis

Jesuyajolu

Zubair

Nicholas

et al. 2022

Surgical Neurology International

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Background: Ventriculoperitoneal shunt (VPS) insertion and endoscopic third ventriculostomy (ETV) are common surgical procedures used to treat pediatric hydrocephalus. There have been numerous studies comparing ETV and VPS, but none from an African perspective. In this study, we sought to compare outcomes from African neurosurgical centers and review the associated complications. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used in conducting this study. PubMed, Google Scholar, and African Journal Online were searched. Data on treatment successes and failures for ETV and VPS were pooled together and analyzed with a binary meta-analysis. A clinically successful outcome was defined as no significant event or complication occurring after surgery and during follow-up (e.g., infection, failure, CSF leak, malfunction, and mortality). Seven studies fully satisfied the eligibility criteria and were used in this review. Results: There was no statistically significant difference between the outcomes of ETV and VPS (OR- 0.27; 95% CI −0.39–0.94, P = 0.42). After reviewing the rates of complications of ETV and VPS from the identified studies, four were recurrent. The infection rates of ETV versus VPS were 0.02% versus 0.1%. The mortality rates were 0.01% versus 0.05%. The reoperation rates were 0.05% versus 0.3%, while the rates of ETV failure and shunt malfunction were 0.2% versus 0.2%. Conclusion: This study concludes that there is no significant difference between the outcomes of ETV and VPS insertion.

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Section: Discussionmentioning

confidence: 99%

Endoscopic third ventriculostomy versus ventriculoperitoneal shunt insertion for the management of pediatric hydrocephalus in African centers – A systematic review and meta-analysis

Jesuyajolu

Zubair

Nicholas

et al. 2022

Surgical Neurology International

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“…Many factors reported in the previous studies may affect surgery result as surgeon skills, cost of surgery and surgery instruments. Lima et al 2014 concluded that ETV is not higher than VP shunt but nearly the same as another operation is needed in children due to shunt failure [18]. The largest study of ETV success in very young children was conducted in Uganda and involved 153 children younger than one year.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt for Infant Hydrocephalus

Abdel-Aziz¹,

Nouby²,

Thabet³

et al. 2020

OJMN

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Introduction: Patients with hydrocephalus, which is the most pediatric neurological disorder, undergo Cerebrospinal fluid (CSF) diversion through third ventriculostomy or ventriculo-peritoneal shunt. Up to date, the optimal hydrocephalus treatment modality is not clear. Aim: We compared the outcome of endoscopic third ventriculostomy (ETV) versus ventriculo-peritoneal shunt (VP shunt) as a second surgical intervention in management of Infant hydrocephalus concerning success rate and complications. Patients and Methods: We conducted an observational study of 52 children with hydrocephalus (congenital or acquired) in whom CSF diversion was performed using either ETV or VP shunt in randomized control trial. Results: During the period examined, 52 children, 26 underwent ETV and 26 underwent VP shunt. The mean age was 11.0 ± 4.3 months in ETV and 11.3 ± 4.7 months in VP shunt. Postoperative infection in the ETV group was lower than in the VP shunt group (23.1% vs. 53.8% P = 0.045). Regarding operating time, In ETV group operation duration was 46.9 min and 64.3 min in the V-P shunt group (P = 0.13). There was no statistically significant difference between the two study groups regarding the rate of obstruction, change in occipital frontal circumference (OFC) or the need of revision surgery. One year survival for VP shunt group vs. ETV group was 46.2% vs. 65.4% respectively. Conclusion: ETV associated with lower rates of postoperative infection and shorter operation time with no significant difference in rates of obstruction, change in OFC and revision surgery in comparison to VP shunt.

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“…Second, neither the Brazilian nor the Canadian study found cost differences between ETV and VPS. 6,10 It is worth noting that the overall cost infrastructure, insurance structure, and patient payment systems of Brazil and Canada greatly differ from those of the United States. The results of cost-effectiveness analyses and the success and failure rates used in our study are etiology-and intervention-dependent.…”

Section: Discussionmentioning

confidence: 99%

“…Investigators in Canada and Brazil (in 2001 and 2014, respectively) conducted cost analyses for ETV, and both studies found no differences in costs when comparing ETV procedures to other CSF diversion procedures. 6,10 Since the patient population and healthcare infrastructure of the United States is different from that of other countries, such as Brazil and Canada, further investigation is warranted. A systematic evaluation of hydrocephalus etiology and long-term financial impact of hydrocephalus treatment is critically important due to the overall rise in healthcare expenditures in the United States and is therefore the aim of this study.…”

mentioning

confidence: 99%

The cost of hydrocephalus: a cost-effectiveness model for evaluating surgical techniques

Lim

Tang

Liles

et al. 2019

Journal of Neurosurgery: Pediatrics

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OBJECTIVEMany studies have aimed to determine the most clinically effective surgical intervention for hydrocephalus. However, the costs associated with each treatment option are poorly understood. In this study, the authors conducted a cost-effectiveness analysis, calculating the incremental cost-effectiveness ratio (ICER) of ventriculoperitoneal shunting (VPS), endoscopic third ventriculostomy (ETV), and ETV with choroid plexus cauterization (ETV/CPC) in an effort to better understand the clinical effectiveness and costs associated with treating hydrocephalus.METHODSThe study cohort includes patients under the age of 18 who were initially treated for hydrocephalus between January 2012 and January 2015 at the authors’ institution. Overall treatment costs were calculated using patient-level hospitalization costs and professional fees reimbursable to the hospital and directly related to the initial and follow-up (postoperative day 1 to 12 months) treatment of hydrocephalus. TreeAge Pro was used to conduct the cost-effectiveness analyses.RESULTSA total of 147 patients were identified. Based on the initial intervention for hydrocephalus, their cases were classified as follows: 113 VPS, 14 ETV, and 20 ETV/CPC. During the initial intervention, VPS patients required a longer length of stay at 5.6 days, compared to ETV/CPC (3.35 days) and ETV (2.36 days) patients. Failure rates for all treatment options ranged from 29% to 45%, leading to recurrent hydrocephalus and additional surgical intervention between postoperative day 1 and 12 months. Cost-effectiveness analyses found ETV to be less costly and more clinically effective, with an ICER of $94,797 compared to VPS ($130,839) and ETV/CPC ($126,394). However, when stratified by etiology, VPS was found to be more clinically effective and cost-effective in both the myelomeningocele and posthemorrhagic hydrocephalus patient groups with an incremental cost per clinical unit of effectiveness (success or failure of intervention) of $76,620 compared to ETV and ETV/CPC. However, when assessing cases categorized as “other etiologies,” ETV was found to be more cost-effective per clinical unit, with an ICER of $60,061 compared to ETV/CPC ($93,350) and VPS ($142,135).CONCLUSIONSThis study is one of the first attempts at quantifying the patient-level hospitalization costs associated with surgical management of hydrocephalus in pediatric patients treated in the United States. The results indicate that the conversation regarding CSF diversion techniques must be patient-specific and consider etiology as well as any previous surgical intervention. Again, these findings are short-run observations, and a long-term follow-up study should be conducted to assess the cost of treating hydrocephalus over the lifetime of a patient.

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Endoscopic third ventriculostomy has no higher costs than ventriculoperitoneal shunt

Cited by 15 publications

References 27 publications

Endoscopic third ventriculostomy versus ventriculoperitoneal shunt insertion for the management of pediatric hydrocephalus in African centers – A systematic review and meta-analysis

Endoscopic third ventriculostomy versus ventriculoperitoneal shunt insertion for the management of pediatric hydrocephalus in African centers – A systematic review and meta-analysis

Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt for Infant Hydrocephalus

The cost of hydrocephalus: a cost-effectiveness model for evaluating surgical techniques

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