College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.
Neurosurgery. 2019 Oct 1;85(4):E765-E770. doi: 10.1093/neuros/nyz090.
Image guidance for shunt surgery results in more accurate proximal catheter placement. However, reduction in shunt failure remains unclear in the literature. There have been no prior studies evaluating the cost effectiveness of neuronavigation for shunt surgery.
To perform a cost analysis using available hospital charges of hypothetical shunt surgery performed with/without electromagnetic neuronavigation (EMN).
Hospital charges were collected for physician fees, radiology, operating room (OR) time and supplies, postanesthesia care unit, hospitalization days, laboratory, and medications. Index shunt surgery charges (de novo or revision) were totaled and the difference calculated. This difference was compared with hospital charges for shunt revision surgery performed under 2 clinical scenarios: (1) same hospital stay as the index surgery; and (2) readmission through the emergency department.
Costs for freehand de novo and revision shunt surgery were $23 946.22 and $23 359.22, respectively. For stealth-guided de novo and revision surgery, the costs were $33 646.94 and $33 059.94, a difference of $9700.72. The largest charge increase was due to additional OR time (34 min; $4794), followed by disposable EMN equipment ($2672). Total effective charges to revise the shunt for scenarios 1 and 2 were $34 622.94 and $35 934.94, respectively. The cost ratios between the total revision charges for both scenarios and the difference in freehand vs EMN-assisted shunt surgery ($9700.72) were 3.57 and 3.70, respectively.
From an economic standpoint and within the limitations of our models, the number needed to prevent must be 4 or less for the use of neuronavigation to be considered cost effective.
分流术的图像引导可实现更准确的近端导管放置。然而，文献中并未明确减少分流失败。此前尚无研究评估分流手术中神经导航的成本效益。
使用假设的分流手术的现有医院收费进行成本分析，该手术有无电磁神经导航（EMN）辅助。
收集医师费用、放射科、手术室（OR）时间和用品、麻醉后护理单位、住院天数、实验室和药物的医院收费。计算指数分流手术（初次或修正）的总费用，并计算差值。将该差值与两种临床情况下的分流修正手术的医院收费进行比较：（1）与索引手术相同的住院时间；（2）通过急诊部门重新入院。
徒手初次和修正分流手术的费用分别为 23946.22 美元和 23359.22 美元。对于 stealth-guided 初次和修正手术，费用分别为 33646.94 美元和 33059.94 美元，差值为 9700.72 美元。最大的费用增加是由于额外的手术室时间（34 分钟；4794 美元），其次是一次性 EMN 设备（2672 美元）。情景 1 和 2 中修正分流的总有效费用分别为 34622.94 美元和 35934.94 美元。两个情景下的总修正费用与徒手与 EMN 辅助分流手术差值之间的成本比（9700.72 美元）分别为 3.57 和 3.70。
从经济角度来看，并且在我们模型的限制内，使用神经导航必须有 4 个或更少的分流术来预防才能被认为具有成本效益。
