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Journal of Neurosurgical Sciences 2022 Sep 09

DOI: 10.23736/S0390-5616.22.05754-X


language: English

Antibiotic-impregnated versus standard silicone catheter for external ventricular drainage in acute hydrocephalus associated to aneurysmal SAH: a budget impact analysis from a single center Italian Cohort

Rina DI BONAVENTURA 1, 2 , Michele BASILE 3, Alessandro OLIVI 1, 2, Americo CICCHETTI 3, Enrico MARCHESE 1, 2

1 Neurosurgery Institute, Università Cattolica del Sacro Cuore, Rome, Italy; 2 Neurosurgery, Aging, Neurological, Orthopedic and Head-Neck Sciences Department, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy; 3 Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy


BACKGROUND: Acute hydrocephalus is a frequent complication of aneurysmal subarachnoid hemorrhage, and it is generally treated by external ventricular drainage. In the last decades, antibiotic-impregnated ventricular catheters have been introduced in the neurosurgical practice in order to reduce secondary cerebrospinal fluid infections which increase morbidity, mortality, and health care costs.
METHODS: Data of 100 patients treated at Fondazione Policlinico Universitario Agostino Gemelli IRCCS between January 2012 and December 2019 were retrospectively reviewed in order to determine the cost-effectiveness and budget impact of antibiotic impregnated versus non-impregnated catheters in the management of patients with aneurysmal subarachnoid hemorrhage related hydrocephalus. A budget impact model was built depending on the use of antibiotic impregnated versus non-impregnated catheters. The model was populated with data extrapolated from existing literature concerning the Italian healthcare setting and national tariffs.
RESULTS: A 25% reduction in the number of cerebrospinal fluid infections was achieved by using antibiotic impregnated catheters, resulting in an overall saving equal to €5.730,52/patient. Expanding results to a 100-patient sample, the possible savings would amount to €573.052,40 for the National Health Service.
CONCLUSIONS: Antibiotic impregnated catheters use was associated to a reduction in cerebrospinal fluid infections rate as well as in costs related to hospital care when compared to non impregnated catheters. Thus these catheters represent, besides lifesaving, cost-saving devices that reduce the economic burden and ensure a safe clinical outcome in patients with aneurysmal subarachnoid hemorrhage related hydrocephalus. The present study provides concrete evidence of the benefit of Antibiotic impregnated catheters to decision-makers responsible of defining health policies.

KEY WORDS: Ventricular catheters; Hydrocephalus; Budget impact analysis; Aneurysmal subarachnoid hemorrhage

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