Cost comparison between the atraumatic and cutting lumbar puncture needles

Abstract

Objective: The aim of this study was to determine which type of spinal needle is preferred from a cost perspective, taking into account costs of the spinal needle and treatment of postlumbar puncture headache. Methods:A decision-analytic model was created to determine the cost of diagnostic lumbar punctures using atraumatic and cutting needles. We assumed a health care system perspective and based the analysis on the treatment of a patient facing event probabilities derived from prior studies. The economic outcome measure was the difference in estimated costs between the 2 needles. One-way and probabilistic sensitivity analyses tested the robustness of the model. Results:Lumbar puncture performed with the atraumatic needle is associated with an average cost savings of $26.07 per patient. Average total health care costs are $166.08 with the atraumatic needle, compared to $192.15 with the cutting needle. There is 94% certainty that the atraumatic needle is cost-saving compared to the cutting needle based on probabilistic sensitivity analysis. Use of the atraumatic needle over the cutting needle by neurologists alone may result in $10.4 million in cost savings to the US health care system per year. Conclusion:The atraumatic spinal needle is associated with an overall cost savings to the US health care system. The balance of costs and benefits favors the use of the atraumatic needle over the cutting needle for diagnostic lumbar puncture. Neurology ® 2012;78:109-113Every year approximately 400,000 diagnostic lumbar punctures are performed by neurologists in the United States. 1 Recent studies have shown that the "atraumatic," pencil-point Sprotte spinal needle is associated with a lower incidence of postlumbar puncture headache compared to the conventional "cutting" Quincke needle. 2,3 Although the use of the atraumatic needle is standard practice among anesthesiologists for spinal anesthesia, only 2% of neurologists routinely use atraumatic needles. The most common reasons given by neurologists for not using the atraumatic needle are nonavailability and expense. 4 There have been no formal decisionanalytic studies evaluating the costs associated with the use of each of these spinal needles. 5 The goal of this study was to determine whether the atraumatic or the cutting spinal needle is preferred from a cost perspective, taking into account the initial procedural costs and the costs associated with treatment of postlumbar puncture headache. METHODS Model overview.A decision-analytic model was created (TreeAge Software, Inc.) to determine the costs of diagnostic lumbar punctures with the atraumatic and cutting spinal needles ( figure 1). In the analysis, we estimated average health care costs of each alternative from the time of the lumbar puncture to the resolution of postlumbar puncture headache. Not experiencing a postlumbar puncture headache and resolution of postlumbar puncture headache are the absorbing states after which the patient is excluded from the model. No further costs incurred by the absorbing ...

Actualización sobre factores de riesgo para cefalea pospunción dural

“…Las agujas espinales atraumáticas tienen una punta en forma de cono circular cerrado con un perfil redondeado y una abertura lateral la cual es mayor que el diámetro interior 27 separando las fibras de la duramadre, ocasionando menos perdida de LCR y por lo tanto menor incidencia de CPPD [29][30][31][32][33][34][35] ; por el contrario, las agujas espinales traumáticas tienen una punta biselada que le permite realizar cortes en las diferentes capas de la duramadre. El costo de las agujas espinales atraumáticas era siete veces mayor que las agujas espinales traumáticas 29,35 , pero en los últimos 14 años su costo ha ido disminuyendo tanto inherente al procedimiento como al manejo de una posible complicación 29,36,37 .…”

Education Research: Changing practice: Residents' adoption of the atraumatic lumbar puncture needle

“…Cost-comparison studies based on the prevention of PDPH would likely show benefit to the health care system. 3 Randomized trials comparing current teaching to that proposed in this WriteClick submission may provide evidence to meet core competencies standards (Accreditation Council for Graduate Medical Education). However, this type of study will not occur in my hospital due to administrative conflicts, a global dilemma that prohibits meaningful research and innovative education.…”

Education Research: Changing practice

“…During these hour-long sessions, evidence was presented from previously published studies regarding the atraumatic needle, including decreased risk of PLPH, cost savings, ease of use, and flow dynamics. [2][3][4][5][6] Residents were given samples of the atraumatic needle (22-G Sprotte) to compare to the cutting needle (20-G Quincke). Residents also observed a lumbar puncture with the atraumatic needle performed on a lumbar puncture simulator and had the opportunity to practice on the simulator.…”