OBJECTIVES

: Endoscopic Third Ventriculostomy (ETV) and Ventriculoperitoneal Shunting (VPS) are the two neurosurgeries to treat hydrocephalus in pediatric patients. VPS is relatively cheaper while associated with higher complication and infection. Although ETV is performed once and it allows patients stay shunt free the technology is expensive and requires special knowledge. Our objective was to assess the cost-effectiveness of ETV vs. VPS in pediatric patients with hydrocephalus.

METHODS

The cost-effectiveness analysis used a Markov model that took a Uzbekistan health system perspective with a 10 years time horizon. The base case involved 3-years- old patient with hydrocephalus. We obtained probabilities, utilities and mortalities from varies clinical studies in paediatric patients with hydrocephalus. The costs and resource utilization were obtained from the Institute of Neurosurgery hospital. Outcomes were quality-adjusted life-years (QALYs) and costs. Probabilistic and deterministic sensitivity analyses were used to incorporate parameter uncertainties

RESULTS

: VPS in the pediatric population with hydrocephalus resulted in the gain of 0,632 quality-adjusted life-years (QALYs) compared with ETV. The incremental cost was USD $1,860 per patient, and the incremental cost-effectiveness ratio (ICER) was $2,945 per QALY gained, which is less than current $4,512 per QALY Willingness-To-Pay threshold for Uzbekistan (3 GDP per Capita). The major drivers of cost-effectiveness were intervention and post-surgery costs, utilities for “successful” health state.

CONCLUSIONS

: Endoscopic Third Ventriculostomy is a good value for money when treating hydrocephalus pediatric patients in Uzbekistan.