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Acta Neurochirurgica
Published in: Acta Neurochirurgica 3/2018

Open Access 01-03-2018 | Original Article - Neurosurgical Techniques

Shunt surgery in idiopathic normal pressure hydrocephalus is cost-effective—a cost utility analysis

Authors: Mats Tullberg, Josefine Persson, Jakob Petersen, Per Hellström, Carsten Wikkelsø, Åsa Lundgren-Nilsson

Published in: Acta Neurochirurgica | Issue 3/2018

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Abstract

Background

The objective was to evaluate the cost-effectiveness of shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH).

Methods

Health-related quality of life was evaluated before and 6 months after surgery using the EQ-5D-3 L (EuroQOL group five-dimensions health survey) in 30 patients (median age, 71 years; range, 65–89 years) diagnosed with iNPH. The costs associated with shunt surgery were assessed by a detailed survey with interviews and extraction of register data concerning the cost of hospital care, primary care, residential care, home-care service and informal care. The cost of untreated patients was derived from the cost of dementia disorders in Sweden in 2012, as reported by the National Board of Health and Welfare. The cost effectiveness analysis used a decision-analytic Markov model. We used a societal perspective and a lifelong time horizon to estimate costs and effects. One-way sensitivity analysis and probabilistic sensitivity analysis were carried out to test the robustness of the model.

Results

The shunt surgery model as the standard treatment in iNPH resulted in a gain of 2.2 life years and 1.7 quality-adjusted life years (QALY), along with an incremental cost per patient of €7,500/QALY. The sensitivity analysis showed that the results were not sensitive to changes in uncertain parameters or assumptions.

Conclusions

Shunt surgery in iNPH, an underdiagnosed condition severely impairing elderly patients, is not only an effective medical treatment, it is also cost-effective, adding 2.2 additional life years and 1.7 QALYs at a low cost, a remarkable gain for an individual aged around 70 years.
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Metadata
Title
Shunt surgery in idiopathic normal pressure hydrocephalus is cost-effective—a cost utility analysis
Authors
Mats Tullberg
Josefine Persson
Jakob Petersen
Per Hellström
Carsten Wikkelsø
Åsa Lundgren-Nilsson
Publication date
01-03-2018
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 3/2018
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-017-3394-7

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