Cerebrospinal fluid leakage costs after craniotomy and health economic assessment of incidence reduction from a hospital perspective in the Netherlands

Chris van Lieshout, Emma M H Slot, Ahmet Kinaci, Mare H Kollen, Eelco W Hoving, Geert W J Frederix, Tristan P C van Doormaal, Chris van Lieshout, Emma M H Slot, Ahmet Kinaci, Mare H Kollen, Eelco W Hoving, Geert W J Frederix, Tristan P C van Doormaal

Abstract

Objectives: We aim to quantify the cost difference between patients with incisional cerebrospinal fluid (iCSF) leakage and those without after intradural cranial surgery. Second, the potential cost savings per patient when a decrease in iCSF leakage rate would be achieved with and without added costs for preventative measures of various price and efficacy are modelled.

Design: Health economic assessment from a hospital perspective based on a retrospective cohort study.

Setting: Dutch tertiary referral centre.

Participants: We included 616 consecutive patients who underwent intradural cranial surgery between 1 September 2017 and 1 September 2018. Patients undergoing burr hole surgery or transsphenoidal surgery, or who died within 1 month after surgery or were lost to follow-up were excluded.

Primary and secondary outcome measures: Outcomes of the cost analysis include a detailed breakdown of mean costs per patient for patients with postoperative iCSF leakage and patients without, and the mean cost difference. For the scenario analyses the outcomes are the potential cost savings per 1000 patients when a decrease in iCSF leakage would be achieved.

Results: Mean cost difference between patients with and without iCSF leakage was €9665 (95%CI, €5125 to €14 205). The main cost driver was hospital stay with a difference of 8.5 days. A 25% incidence reduction would result in a mean cost saving of -€94 039 (95% CI, -€218 258 to -€7077) per 1000 patients. A maximum cost reduction of -€653 025 (95% CI, -€1 204 243 to -€169 120) per 1000 patients could be achieved if iCSF leakage would be reduced with 75% in all patients, with 72 cases of iCSF leakage avoided.

Conclusions: Postoperative iCSF leakage after intradural cranial surgery increases healthcare costs significantly and substantially. From a health economic perspective preventative measures to avoid iCSF leakage should be pursued.

Keywords: health economics; neurosurgery.

Conflict of interest statement

Competing interests: CvL and GWJF received a consultancy fee through Polyganics B.V. for this research.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Potential costs savings per patient with a decrease in incisional cerebrospinal fluid leakage.
Figure 2
Figure 2
Cost difference per patient, per change in incidence and cost for preventative measure.
Figure 3
Figure 3
Tornado diagram indicting the influence of the different input parameters of the model.

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