Background: We showed that ventriculoperitoneal (VP) shunt and lumboperitoneal (LP) shunt surgeries are beneficial for patients with idiopathic normal pressure hydrocephalus (iNPH) in the Study of Idiopathic Normal Pressure Hydrocephalus on Neurological Improvement (SINPHONI; a multicenter prospective cohort study) and in SINPHONI-2 (a multicenter randomized trial). Although therapeutic efficacy is important, cost-effectiveness analysis is equally valuable.
Methods: Using both a set of assumptions and using the data from SINPHONI and SINPHONI-2, we estimated the total cost of treatment for iNPH, which consists of medical expenses (e.g., operation fees) and costs to the long-term care insurance system (LCIS) in Japan. Regarding the natural course of iNPH patients, 10% or 20% of patients on each modified Rankin Scale (mRS) show aggravation (aggravation rate: 10% or 20%) every 3 months if the patients do not undergo shunt surgery, as described in a previous report. We performed cost-effectiveness analyses for the various scenarios, calculating the quality-adjusted life year (QALY) and the incremental cost-effective ratio (ICER). Then, based on the definition provided by a previous report, we assessed the cost-effectiveness of shunt surgery for iNPH.
Results: In the first year after shunt surgery, the ICER of VP shunt varies from 29,934 to 40,742 USD (aggravation rate 10% and 20%, respectively) and the ICER of LP shunt varies from 58,346 to 80,392 USD (aggravation rate 10% and 20%, respectively), which indicates that the shunt surgery for iNPH is a cost-effective treatment. In the 2nd postoperative year, the cost to the LCIS will continue to decrease because of the lasting improvement of the symptoms due to the surgery. The total cost for iNPH patients will show a positive return on investment in as soon as 18 months (VP) and 21 months (LP), indicating that shunt surgery for iNPH is a cost-effective treatment.
Conclusions: Because the total cost for iNPH patients will show a positive return on investment within 2 years, shunt surgery for iNPH is a cost-effective treatment and therefore recommended. The SINPHONI-2 study was registered with the University Hospital Medical Information Network Clinical Trials registry: UMIN000002730) SINPHONI was registered with ClinicalTrials.gov, no. NCT00221091.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1007/s00701-017-3115-2 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Reversed valved Potts shunt for refractory primary pulmonary arterial hypertension.
Multimed Man Cardiothorac Surg
January 2025
• Pediatric and Congenital Cardiac Surgery, LMU University Hospital, Munich, Germany • Congenital Cardiac Surgery, German Heart Center Munich, Munich, Germany • European Pediatric Heart Center EKHZ Munich, Munich, Germany.
This procedure is carried out via a full sternotomy using standard aortic and bicaval cannulations. For the aortic and pulmonary anastomoses, selective antegrade unilateral cerebral perfusion is used after cooling the body temperature to 26 °Celsius. A 12-mm Hancock conduit is interposed between the pulmonary artery and the proximal descending aorta using standard running suture techniques.
View Article and Find Full Text PDFAscending aorta dilatation for pulmonary atresia with ventricular septal defect: a report of three adult cases.
J Cardiothorac Surg
January 2025
The First Hospital of Tsinghua University, Tsinghua University, Beijing, China.
Background: Patients with pulmonary atresia and ventricular septal defect (PA/VSD) are prone to progressive aortic dilation. However, there are relatively few reports of progressive development of aortic aneurysm or aortic dissection in adult patients who missed early corrective surgery.
Presentation Of Cases: Case 1: A 38-year-old man with PA/VSD and a bicuspid aortic valve (BAV), underwent VSD repair, aortic valve replacement, and PA correction at age 21.
Comparison of clinical outcomes in patients with refractory ascites treated with either TIPS, tunneled peritoneal catheter, or ascites pump.
Hepatol Commun
February 2025
Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.
Background: Refractory ascites (RA) remains a serious complication in patients with cirrhosis. Currently, the insertion of a TIPS is considered the standard of care in these patients. To achieve symptom control in those with TIPS contraindications, tunneled peritoneal catheters (PeCa) or ascites pumps were introduced.
View Article and Find Full Text PDFSuperficial temporal artery-to-middle cerebral artery side-to-side microvascular anastomosis using the in-situ intraluminal suturing technique.
Acta Neurochir (Wien)
January 2025
Department of Neurosurgery, The Fourth Affiliated Hospital of Soochow University, Suzhou, China.
Background: Superficial temporal artery (STA)-middle cerebral artery (MCA) side-to-side microvascular anastomosis can achieve the same clinical effects as traditional STA-MCA end-to-side anastomosis in extracranial-intracranial revascularization surgery, furthermore, STA-MCA side-to-side anastomosis has the lower risk of postoperative cerebral hyperperfusion syndrome (CHS) and the potential to recruit all scalp arteries as the donor sources via self-regulation. Therefore, STA-MCA side-to-side microvascular anastomosis seems to be a revascularization strategy superior to traditional STA-MCA end-to-side anastomosis. In this study, we presented seven cases in which a STA-MCA side-to-side microvascular anastomosis was performed with a 4-5 mm long arteriotomy using the in-situ intraluminal suturing technique.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!