Hilvert Austin M, Gauhar Fatima, Longo Michael, Peterson Keyan, Velagapudi Lohit, Bishay Anthony, Dugan John, Sundrani Sameer, Grimaudo Heather, Mummareddy Nishit, Liles Campbell, Raygor Kunal, Chitale Rohan, Froehler Michael, Fusco Matthew R
Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Interv Neuroradiol. 2025 Sep 10:15910199251377487. doi: 10.1177/15910199251377487.
IntroductionVenous sinus stenting (VSS) is an effective, less invasive alternative to ventriculoperitoneal shunting (VPS) for idiopathic intracranial hypertension (IIH). While efficacy is comparable, with some evidence favoring VSS for headache control, perioperative costs remain under-characterized due to reliance on reimbursement rates rather than actual expenditures.ObjectiveTo compare the perioperative cost of elective VSS and VPS for IIH, including outpatient workup and follow-up costs, using detailed institutional cost data.MethodsWe retrospectively analyzed IIH patients treated with VSS or VPS from 2017 to 2022 at a single center. All IIH-related costs were captured from 90 days pre-op through 90 days post-op and categorized as fixed (e.g. OR staff) or variable (e.g. supplies). Patients with fulminant IIH or unrelated elective procedures were excluded. Comparisons used Mann-Whitney U and Fisher's exact tests (p < 0.05).ResultsForty-three patients met criteria (VSS n = 19, VPS n = 24), with no significant differences in age, body mass index, papilledema, opening pressure, or pulsatile tinnitus. Preoperative costs were significantly higher for VSS (median $14,951 [IQR 10,835-16,043] vs $4767 [1, 293, 410-11]; p = 0.008), including both variable (p = 0.008) and fixed (p = 0.015) cost components. Surgical admission costs were similar between groups (p = 0.403), as were postoperative costs (p = 0.509). Total 180-day costs remained significantly higher for VSS ($38,576 [011-43, 36, 590]) compared to VPS ($31,509 [25, 208-37, 342]; p = 0.001).ConclusionVSS incurs higher preoperative and total costs than VPS. Streamlining VSS workup may improve value. Further studies should assess downstream cost avoidance to determine long-term cost-effectiveness.
引言
对于特发性颅内高压（IIH），静脉窦支架置入术（VSS）是一种有效且侵入性较小的替代脑室腹腔分流术（VPS）的方法。虽然疗效相当，有一些证据表明VSS在控制头痛方面更具优势，但由于依赖报销率而非实际支出，围手术期成本仍未得到充分描述。
目的
使用详细的机构成本数据，比较IIH患者择期VSS和VPS的围手术期成本，包括门诊检查和随访成本。
方法
我们回顾性分析了2017年至2022年在单一中心接受VSS或VPS治疗的IIH患者。收集所有与IIH相关的成本，从术前90天到术后90天，并分为固定成本（如手术室工作人员）或可变成本（如耗材）。排除暴发性IIH患者或无关的择期手术患者。比较采用Mann-Whitney U检验和Fisher精确检验（p < 0.05）。
结果
43例患者符合标准（VSS组19例，VPS组24例），在年龄、体重指数、视乳头水肿、初压或搏动性耳鸣方面无显著差异。VSS的术前成本显著更高（中位数为14,951美元[四分位间距10,835 - 16,043美元]，而VPS为4767美元[1,293,410 - 11美元]；p = 0.008），包括可变成本（p = 0.008）和固定成本（p = 0.015）部分。两组的手术住院成本相似（p = 0.403），术后成本也相似（p = 0.509）。与VPS（31,509美元[25,208 - 37,342美元]）相比，VSS的180天总成本仍然显著更高（38,576美元[011 - 43,36,590美元]；p = 0.001）。
结论
VSS的术前成本和总成本高于VPS。简化VSS检查可能会提高价值。进一步的研究应评估下游成本避免情况，以确定长期成本效益。
