Wetzelaer Pim, Vlis Tim, Tonge Mehmet, Ackermans Linda, Kubben Pieter, Evers Silvia, Kocabicak Ersoy, Temel Yasin
Maastricht University, Faculty of Psychology and Neuroscience, Department of Clinical Psychological Science, Maastricht, The Netherlands.
Turk Neurosurg. 2018;28(6):929-933. doi: 10.5137/1019-5149.JTN.21511-17.1.
To investigate the costs of treating the infection with antibiotics only with the risk of surgery when unsuccessful versus immediate removal followed by re-implantation in patients with deep brain stimulation (DBS) hardware infection.
We calculated the costs of the different strategies through a standard costing procedure. A decision model has been applied to establish the average treatment cost per patient representative for a clinical setting where both strategies are employed. Subsequently, a sensitivity analysis has been performed to assess the influence of clinical assumptions regarding the effectiveness of antibiotics treatment on average treatment costs.
The costs of treating a case of DBS hardware infection with immediate internal pulse generator (IPG) replacement surgery were ?29,301 compared to ?9499 for successful antibiotic treatment. For antibiotic treatment followed by IPG replacement surgery the total costs were ?38,741. Antibiotic treatment alone was successful in 44% (4/9) of the included cases of DBS infection, resulting in average treatment costs per patient of ?25,745. Trying to resolve DBS hardware infections initially with antibiotics reduced treatment costs by 12.1%.
Treatment with antibiotics with the risk of a later removal when unsuccessful was a more valuable strategy in terms of costs when compared to immediate surgical intervention in cases of hardware-related infections in DBS surgeries.
探讨对于脑深部电刺激（DBS）硬件感染患者，仅使用抗生素治疗感染（治疗失败时有手术风险）与立即移除硬件随后重新植入相比的治疗成本。
我们通过标准成本核算程序计算了不同策略的成本。应用决策模型来确定在采用这两种策略的临床环境中每位患者的平均治疗成本。随后，进行了敏感性分析，以评估关于抗生素治疗有效性的临床假设对平均治疗成本的影响。
对于DBS硬件感染病例，立即进行植入式脉冲发生器（IPG）置换手术的治疗成本为29,301英镑，而成功进行抗生素治疗的成本为9499英镑。对于先进行抗生素治疗随后进行IPG置换手术，总成本为38,741英镑。在纳入的DBS感染病例中，仅抗生素治疗有44%（4/9）成功，导致每位患者的平均治疗成本为25,745英镑。最初尝试用抗生素解决DBS硬件感染可使治疗成本降低12.1%。
与DBS手术中硬件相关感染时立即进行手术干预相比，使用抗生素治疗（治疗失败时后期有移除风险）在成本方面是一种更有价值的策略。
