Cost analysis of antibiotic-impregnated catheters in the treatment of hydrocephalus in adult patients

S. Harrison Farber, Scott L. Parker, Owoicho Adogwa, Daniele Rigamonti, Matthew J. McGirt

Research output: Contribution to journalReview articlepeer-review

17 Scopus citations


Objective To determine if use of antibiotic-impregnated shunt (AIS) systems to reduce cerebrospinal fluid (CSF) shunt infections in adult patients with hydrocephalus has been cost-effective at one institution. Methods All adult patients undergoing CSF shunt insertion over a 7-year period at the Johns Hopkins Hospital were retrospectively reviewed (20042009). In 2006, a categorical switch to AIS catheters was made. Before 2006, standard nonimpregnated shunt catheters were used. The 1-year incidence of shunt infection was retrospectively assessed and accounting and billing records were reviewed to determine shunt infectionrelated medical costs for patients undergoing AIS vs non-AIS shunt surgery. Results A total of 500 (250 AIS, 250 non-AIS) shunt surgeries were performed for normal-pressure hydrocephalus (NPH) (n = 378 [76%]), pseudotumor cerebri (n = 83 [17%]), and various obstructive and communicating hydrocephalus etiologies (n = 40 [8%]). The incidence of shunt infection was decreased in the AIS (1.2%) vs non-AIS (4.0%) cohorts (P = .0492. Overall, the mean cost per shunt infection was $40,371. Per 250 shunts placed, the total infection-related cost was reduced from $321,407 to $203,424 after the conversion to AIS catheters. AIS catheters were associated with direct cost savings of $47,193 per 100 shunt surgeries performed. Conclusions In a retrospective cohort study of 500 CSF shunt surgeries performed in adult patients with hydrocephalus, this institution's categorical conversion to AIS catheters was associated with a significant reduction in infection-related medical costs within the first year after surgery. Although prospective randomized cost-utility studies are needed to confirm these observations, these results suggest that AIS catheters are cost-effective in the treatment of hydrocephalus in adult patients.

Original languageEnglish (US)
Pages (from-to)528-531
Number of pages4
JournalWorld neurosurgery
Issue number4-5
StatePublished - 2010
Externally publishedYes


  • Adult
  • Antibiotic-impregnated catheter
  • Antibiotic-impregnated shunt
  • Hydrocephalus

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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