Transverse sinus stenting for pseudotumor cerebri: a cost comparison with CSF shunting

Abstract

Background and purpose: Transverse sinus venous stent placement has been shown to lower intracranial pressure in patients with venogenic pseudotumor cerebri and to reverse, or at least stabilize, its symptoms and signs. There have been no studies comparing the cost of venous stenting with the time-honored treatment for pseudotumor cerebri-CSF shunting. The purpose of this study was to compare the cost of trasverse sinus stenting versus CSF shunting for the treatment of pseudotumor cerebri.

Materials and methods: This work was a retrospective cost analysis of individual resource use in 86 adults who were stented for pseudotumor cerebri during a 12-year period compared with resource use in 110 children who were shunted for hydrocephalus during a 3-year period.

Results: There was no significant difference between the cost of inserting an initial venous stent ($13,863 ± 4890) versus inserting an initial CSF shunt ($15,797 ± 5442) (P = .6337) or between inserting an additional venous stent ($9421 ± 69) versus revising a CSF shunt ($10,470 ± 1245) (P = .4996). There were far fewer additional venous stent insertions per patient than there were subsequent CSF shunt revisions; 87% of stents placed required just 1 stent procedure, whereas only 45% of shunts required 1 shunt procedure. The main cause of the cost difference was the need for repeated revisions of the shunts, especially when they became infected-24 instances of a total 143 shunt procedures (16.8%) at an average cost of $84,729, approximately 5 times the cost of an initial shunt insertion.

Conclusions: Venous stenting costs significantly less per 100 procedures than does CSF shunting, due largely to the high cost of treating shunt infections and the need for repeated shunt revisions.

Fig 1.

Stent versus shunt. Cost comparison per 100 procedures. Graph shows the average cost per 100 procedures of transverse sinus stenting versus CSF shunting. The total cost is shown, plus an individual breakdown of costs based on revision and infection rates of each group.

Fig 2.

Stent versus shunt. Cost (AUD) per patient by percentile of the group and the length of stay. Graph shows highest-to-lowest cost per patient by percentile for transverse sinus stenting (blue) and CSF shunting (red). The length of hospital stay (LOS) is also shown for each group.

Fig 3.

Stents versus shunts by the total number of shunt revisions or additional stents per patient. Graph shows the cost of transverse sinus stenting versus CSF shunting for both new procedures versus a variable number of revisions. Ongoing CSF shunt revision costs are compared with the maximum reported TSS cases of 5 (dotted triangle). Predicted costs for CSF shunting are also shown, with reduced infection rate scenarios of 5% and 10% for the variable number of revisions.