OBJECTIVES: Posterior fossa surgeries are common in treating tumours, vascular malformation, cerebellar hematomas, Chiari malformations and traumatic lesions. Most of these procedures entail dural violation and mandatorily require accurate dural repair to prevent postoperative cerebrospinal fluid (CSF) leaks, infections and other complications. To aid the healing process and to protect the patient from CSF leaks and pathogens, fibrin glue (FG) can be used to seal the operative site. The same authors have found that polyethylene glycol (PEG) hydrogel is associated with better safety than FG. This work aims to evaluate the budget-impact of switching from FG to PEG in Belgium, France, Germany, Italy, and the United Kingdom.

METHODS: A decision-tree model comparing FG with PEG was adapted for five European countries. The observational time encompasses from surgery to four months after discharge. A structured review of PubMed identified Europe-specific efficacy and cost data relevant to posterior fossa surgery and sealing of the access site. The model accounted for postoperative events and length of stay. The application of dural sealants was assumed not to impact operating time. Cost data were sourced from official reimbursement information and published literature. To account for the effect of key variables and input data, a one-way sensitivity analysis (OWSA) was carried out.

RESULTS: For all five countries, the change from FG to PEG may be cost-saving. The model estimated a sizeable reduction in costs between 18% and 26% with PEG hydrogel compared to FG. The higher costs of the sealant were offset by the reduction in CSF leak-related costs and a reduction in the average length of stay. The OWSA showed that cost savings were retained if the CSF leak incidence was assumed equal for both sealants.

CONCLUSIONS: The adoption of PEG hydrogel could be a cost-saving strategy for the five investigated countries.