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

Journal article
Authors Mats Tullberg
Josefine Persson
Jakob Petersen
Per Hellström
Carsten Wikkelsö
Åsa Lundgren Nilsson
Published in Acta Neurochirurgica
Volume 160
Issue 3
Pages 509-518
ISSN 0001-6268
Publication year 2017
Published at Institute of Neuroscience and Physiology
Centre for Health Economics
Institute of Medicine, Department of Public Health and Community Medicine, Health Metrics
Pages 509-518
Language en
Links https://doi.org/10.1007/s00701-017-...
Keywords Idiopathic normal pressure hydrocephalus, Shunt surgery, Cost effectiveness, Cost utility analysis, Quality of life, Markov model
Subject categories Surgery, Health Care Service and Management, Health Policy and Services and Health Economy, Neurology

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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