Pandit Anand S, Kamal Muhammad A, Reischer Gerda, Aldabbagh Yousif, Alradhawi Mohammad, Lee Faith M Y, Sekhon Priya P, Moncur Eleanor M, Banks Ptolemy D W, Thompson Simon, Thorne Lewis, Watkins Laurence D, Toma Ahmed K
Victor Horsley Department of Neurosurgery, National Hospital for Neurology & Neurosurgery, London, UK.
High-Dimensional Neurology, Institute of Neurology, University College London, London, UK.
Neurosurgery. 2024 Mar 6;95(1):224-33. doi: 10.1227/neu.0000000000002893.
Implantable telemetric intracranial pressure (ICP) sensors (telesensors) enable routine, noninvasive ICP feedback, aiding clinical decision-making and attribution of pressure-related symptoms in patients with cerebrospinal fluid shunt systems. Here, we aim to explore the impact of these devices on service demand and costs in patients with adult hydrocephalus.
We performed an observational propensity-matched control study, comparing patients who had an MScio/Sensor Reservoir (Christoph Miethke, GmbH & Co) against those with a nontelemetric reservoir inserted between March 2016 and March 2018. Patients were matched on demographics, diagnosis, shunt-type, and revision status. Service usage was recorded with frequencies of neurosurgical admissions, outpatient clinics, scans, and further surgical procedures in the 2 years before and after shunt insertion.
In total, 136 patients, 73 telesensors, and 63 controls were included in this study (48 matched pairs). Telesensor use led to a significant decrease in neurosurgical inpatient admissions, radiographic encounters, and procedures including ICP monitoring. After multivariate adjustment, the mean cumulative saving after 2 years was £5236 ($6338) in telesensor patients (£5498 on matched pair analysis). On break-even analysis, cost-savings were likely to be achieved within 8 months of clinical use, postimplantation. Telesensor patients also experienced a significant reduction in imaging-associated radiation (4 mSv) over 2 years.
The findings of this exploratory study reveal that telesensor implantation is associated with reduced service demand and provides net financial savings from an institutional perspective. Moreover, telesensor patients required fewer appointments, invasive procedures, and had less radiation exposure, indicating an improvement in both their experience and safety.
植入式遥测颅内压（ICP）传感器（遥测传感器）可实现常规、非侵入性的ICP反馈，有助于临床决策以及对脑脊液分流系统患者压力相关症状的归因分析。在此，我们旨在探讨这些设备对成人脑积水患者服务需求和成本的影响。
我们进行了一项观察性倾向匹配对照研究，比较了在2016年3月至2018年3月期间植入MScio/传感器储液器（Christoph Miethke公司）的患者与植入非遥测储液器的患者。根据人口统计学、诊断、分流类型和翻修状态对患者进行匹配。记录分流植入前后2年神经外科住院次数、门诊就诊次数、扫描次数以及进一步手术操作的频率来统计服务使用情况。
本研究共纳入136例患者，其中73例使用遥测传感器，63例为对照组（48对匹配组）。使用遥测传感器导致神经外科住院次数、影像学检查次数以及包括ICP监测在内的操作次数显著减少。多因素调整后，遥测传感器组患者2年后平均累计节省5236英镑（6338美元）（匹配组分析为5498英镑）。通过盈亏平衡分析，临床使用植入后8个月内可能实现成本节约。遥测传感器组患者在2年内的影像学相关辐射也显著减少（4毫希沃特）。
这项探索性研究的结果表明，植入遥测传感器与服务需求减少相关，并且从机构角度来看可实现净财务节省。此外，使用遥测传感器的患者所需预约、侵入性操作较少，辐射暴露也较少，这表明他们的体验和安全性均有所改善。
