OBJECTIVES: An external ventricular drain (EVD) is the first-line, interim intervention in a variety of acute brain injuries requiring cerebrospinal fluid (CSF) diversion. However, EVD catheters pose a significant risk of CSF infection, forcing replacement of the contaminated catheter, systemic antibiotics treatment, and prolonged hospitalisation. Reducing systemic antibiotics use and the emergence of antibiotic-resistant bacteria is a focus of many healthcare systems. Antibiotic-impregnated EVDs can be used to replace systemic antibiotics and reduce the infection risk. The present model estimated the cost impact of transitioning to antibiotic-impregnated EVDs in France, Germany, Italy, and the United Kingdom (UK).

METHODS: A decision-tree model compared treatment with either conventional or antibiotic-impregnated catheters. The input costs were detailed for the index procedure, consumables, antibiotic use, and revision due to infections to simulate the hospital resource consumption. Cost data were sourced from both official reimbursement documentation and published literature for each country. Clinical inputs included only EVD-related adverse events and the use of systemic antibiotics. The model estimated a 1-year time horizon from the local hospital payers’ perspective. Cost drivers were evaluated using one-way sensitivity analysis.

RESULTS: The antibiotic-impregnated EVD system appears advantageous across the four examined European countries. Costs per patient were reduced in all countries, with savings ranging from 1.8% (France) to 3.1% (UK). In monetary terms, savings were estimated to be €405 (France), €469 (Italy), €497 (Germany), and £839 (UK). Savings from reduced use of systemic, intravenous antibiotics accounted for up to 55% (France) of savings accrued. Cutbacks in infection-related management expenses from improved antibiotic prophylaxis effectively offset the higher procurement costs of the impregnated catheters. Length of stay was the largest driver of total costs of care.

CONCLUSIONS: Antibiotic-impregnated EVD catheters are expected to offer a cost-saving alternative to systemic antibiotic use in the four European countries examined.