OBJECTIVES : Hydrocephalus is the pathological accumulation of cerebrospinal fluid in the cerebral ventricles. If left untreated, progressive hydrocephalus leads to high mortality and severe neurological outcomes. The most common treatment method is the placement of the ventriculoperitoneal shunt (VPS). The objective of the study was to evaluate the budget impact of antibiotic-impregnated VPS vs. standard silicone VPS on healthcare systems in England, France, Germany, and Italy over a one-year time horizon.

METHODS : Decision-analytic modelling was used. The model considered the initial placement of the shunt and revision surgery due to catheter-related infections and other reasons. Clinical data were obtained from the BASICS RCT and the UK Shunt Registry. Cost data were obtained from the local sources. The analysis was performed for a cohort of 100 patients, including a mix of adult and pediatric patients.

RESULTS : The use of the antibiotic-impregnated VPS led to a reduction of infection-related revisions by 3.87 for the cohort of 100 patients. When only infection-related revisions were considered, the budget impact of antibiotic-impregnated VPS was -£50,220 in England, -€23,076 in France, -€22,445 in Germany, and -€29,362 in Italy for the cohort of 100 patients. When all types of revisions were considered, antibiotic-impregnated VPS was still cost saving to the system, but the magnitude of saving was smaller.

CONCLUSIONS : In summary, the use of antibiotic-impregnated shunt leads to better patient outcomes, reduced morbidity, and reduced cost to the health care system. The use of antibiotic-impregnated shunts should be prioritized over standard silicone shunts to achieve the best clinical and economic outcomes.