Institutional cost comparison of endoscopic third ventriculostomy and ventriculoperitoneal shunt in the management of obstructive hydrocephalus

Abstract

Background: Abnormal accumulation of cerebrospinal fluid (CSF) in the ventricle of the brain is termed as hydrocephalus. The management of hydrocephalus depends upon two neurosurgical conditions, such as Endoscopic Third Ventriculostomy (ETV) and Ventriculoperitoneal (VP) shunt. Both procedures are effective, but their cost effectiveness differs significantly. This study was designed to compare the institutional provided cost data of both these procedures and to highlight their financial complications for economic and effective treatment of choice for patients and healthcare providers.

Material & Methods: This study was conducted at Ali Institute of Neuroscience, Irfan General Hospital, Peshawar. Ethical approval for the study was obtained from IRB. A cost analysis was conducted using institutional billing records. The cost component consists of surgeon fees, hospital charges and shunt device costs (in the case of VP shunt).

Results: The standardized institutional cost for a single ETV procedure was Rs. 70,000–85,000 PKR lower than VP shunt, thereby reducing the financial burden on patients. Moreover, VP shunt procedures are associated with higher long-term costs due to shunt failure, infections and revision surgeries which further increase the financial burden on patients and healthcare systems.

Conclusion: This institutional cost analysis provides clear evidence that ETV is a more cost-effective alternative to VP shunting in the treatment of hydrocephalus. Given its lower initial cost and reduced long term financial burden, ETV appears to be a more cost-effective option for appropriately selected patients to optimize healthcare resources and minimize economic strain.