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Acta Neurochirurgica

, Volume 159, Issue 6, pp 995–1003 | Cite as

Cost-effectiveness analysis of shunt surgery for idiopathic normal pressure hydrocephalus based on the SINPHONI and SINPHONI-2 trials

  • Masahiro KamedaEmail author
  • Shigeki Yamada
  • Masamichi Atsuchi
  • Teruo Kimura
  • Hiroaki Kazui
  • Masakazu Miyajima
  • Etsuro Mori
  • Masatsune Ishikawa
  • Isao Date
  • the SINPHONI and SINPHONI-2 Investigators
Original Article - Functional

Abstract

Background

We showed that ventriculoperitoneal (VP) shunt and lumboperitoneal (LP) shunt surgeries are beneficial for patients with idiopathic normal pressure hydrocephalus (iNPH) in the Study of Idiopathic Normal Pressure Hydrocephalus on Neurological Improvement (SINPHONI; a multicenter prospective cohort study) and in SINPHONI-2 (a multicenter randomized trial). Although therapeutic efficacy is important, cost-effectiveness analysis is equally valuable.

Methods

Using both a set of assumptions and using the data from SINPHONI and SINPHONI-2, we estimated the total cost of treatment for iNPH, which consists of medical expenses (e.g., operation fees) and costs to the long-term care insurance system (LCIS) in Japan. Regarding the natural course of iNPH patients, 10% or 20% of patients on each modified Rankin Scale (mRS) show aggravation (aggravation rate: 10% or 20%) every 3 months if the patients do not undergo shunt surgery, as described in a previous report. We performed cost-effectiveness analyses for the various scenarios, calculating the quality-adjusted life year (QALY) and the incremental cost-effective ratio (ICER). Then, based on the definition provided by a previous report, we assessed the cost-effectiveness of shunt surgery for iNPH.

Results

In the first year after shunt surgery, the ICER of VP shunt varies from 29,934 to 40,742 USD (aggravation rate 10% and 20%, respectively) and the ICER of LP shunt varies from 58,346 to 80,392 USD (aggravation rate 10% and 20%, respectively), which indicates that the shunt surgery for iNPH is a cost-effective treatment.

In the 2nd postoperative year, the cost to the LCIS will continue to decrease because of the lasting improvement of the symptoms due to the surgery. The total cost for iNPH patients will show a positive return on investment in as soon as 18 months (VP) and 21 months (LP), indicating that shunt surgery for iNPH is a cost-effective treatment.

Conclusions

Because the total cost for iNPH patients will show a positive return on investment within 2 years, shunt surgery for iNPH is a cost-effective treatment and therefore recommended.

The SINPHONI-2 study was registered with the University Hospital Medical Information Network Clinical Trials registry: UMIN000002730)

SINPHONI was registered with ClinicalTrials.gov, no. NCT00221091.

Keywords

iNPH Ventriculoperitoneal shunt Lumboperitoneal shunt Cost-effectiveness analysis 

Notes

Acknowledgements

This study was a project of the Japanese Society of Normal-Pressure Hydrocephalus. We thank the patients for their participation. We would also like to thank both the people who agreed to participate in this trial and the study contributors.

Author contributions

Conception and design: all authors; acquisition of data: all authors; analysis and interpretation of data: all authors; drafting of the article: Kameda; critically reviewing the article: all authors; revising the manuscript: Kameda; reviewing the submitted version of the manuscript: all authors; statistical analysis: Kameda and Yamada; administrative/technical/material support: all authors; study supervision: Atsuchi, Kimura, Kazui, Miyajima, Mori, Ishikawa, and Date.

Compliance with Ethical Standards

Funding

Johnson & Johnson and Nihon Medi-Physics provided financial support to the SINPHONI-2 study [10], and Johnson & Johnson, Nihon Medi-Physics, and Daiichi Pharmaceuticals Co. provided financial support to the SINPHONI study [9]. These sponsors had no role in the design or conduct of this research.

Conflict of Interest

Dr. Miyajima receives clinical and research support from Johnson & Johnson K.K., Inc. (Japan), and Nihon Medi-Physics Co., Ltd. (Japan). Dr. Ishikawa receives lecture fees from Codman and Shurtleff (Japan) and Medtronic Corp. (Japan). Dr. Mori receives honoraria from Johnson & Johnson K.K., Inc.

Dr. Kazui received donations for the 15th Japan Congress of Normal Pressure Hydrocephalus from Johnson & Johnson K.K., Nihon Medi-Physics Co., Ltd., and Medtronic, Inc. and speaker’s honoraria from Johnson & Johnson K.K., Nihon Medi-Physics Co., Ltd., and Medtronic, Inc.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Al-Tamimi YZ, Sinha P, Chumas PD, Crimmins D, Drake J, Kestle J, British Pediatric Neurosurgery Group Audit C, Hayward R, Solanki GA, Thomson S, Thorne J (2014) Ventriculoperitoneal shunt 30-day failure rate: a retrospective international cohort study. Neurosurgery 74:29–34CrossRefPubMedGoogle Scholar
  2. 2.
    Andren K, Wikkelso C, Tisell M, Hellstrom P (2014) Natural course of idiopathic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 85:806–810CrossRefPubMedGoogle Scholar
  3. 3.
    Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Avezaat CJ, de Jong DA, Gooskens RH, Hermans J (1997) Dutch normal-pressure hydrocephalus study: prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid. J Neurosurg 87:687–693CrossRefPubMedGoogle Scholar
  4. 4.
    Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Avezaat CJ, de Jong DA, Gooskens RH, Hermans J (1998) Dutch Normal-Pressure Hydrocephalus Study: randomized comparison of low- and medium-pressure shunts. J Neurosurg 88:490–495CrossRefPubMedGoogle Scholar
  5. 5.
    Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer JA, Avezaat CJ, de Jong DA, Gooskens RH, Hermans J (1998) Does CSF outflow resistance predict the response to shunting in patients with normal pressure hydrocephalus? Acta neurochirurgica. Supplement 71:331–333Google Scholar
  6. 6.
    Christensen MC, Morris S (2008) Association between disability measures and short-term health care costs following intracerebral hemorrhage. Neurocrit Care 9:313–318CrossRefPubMedGoogle Scholar
  7. 7.
    Egeler-Peerdeman SM, Barkhof F, Walchenbach R, Valk J (1998) Cine phase-contrast MR imaging in normal pressure hydrocephalus patients: relation to surgical outcome. Acta Neurochir Suppl 71:340–342PubMedGoogle Scholar
  8. 8.
    Fletcher JJ, Kotagal V, Mammoser A, Peterson M, Morgenstern LB, Burke JF (2015) Cost-effectiveness of transfers to centers with neurological intensive care units after intracerebral hemorrhage. Stroke: J Cerebral Circ 46:58–64CrossRefGoogle Scholar
  9. 9.
    Hashimoto M, Ishikawa M, Mori E, Kuwana N, Study of Ioni (2010) Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRI-based scheme: a prospective cohort study. Cerebrospinal Fluid Res 7:18CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Kazui H, Miyajima M, Mori E, Ishikawa M, Investigators S (2015) Lumboperitoneal shunt surgery for idiopathic normal pressure hydrocephalus (SINPHONI-2): an open-label randomised trial. Lancet Neurol 14:585–594CrossRefPubMedGoogle Scholar
  11. 11.
    Laupacis A, Feeny D, Detsky AS, Tugwell PX (1992) How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ : Can Med Assoc J = J l’Assoc Med Can 146:473–481Google Scholar
  12. 12.
    Menger RP, Connor DE Jr, Thakur JD, Sonig A, Smith E, Guthikonda B, Nanda A (2014) A comparison of lumboperitoneal and ventriculoperitoneal shunting for idiopathic intracranial hypertension: an analysis of economic impact and complications using the Nationwide Inpatient Sample. Neurosurg Focus 37, E4CrossRefPubMedGoogle Scholar
  13. 13.
    Miyajima M, Kazui H, Mori E, Ishikawa M, Sinphoni-Investigators obot (2016) One-year outcome in patients with idiopathic normal-pressure hydrocephalus: comparison of lumboperitoneal shunt to ventriculoperitoneal shunt. Journal of neurosurgery:1–10Google Scholar
  14. 14.
    Mori E, Ishikawa M, Kato T, Kazui H, Miyake H, Miyajima M, Nakajima M, Hashimoto M, Kuriyama N, Tokuda T, Ishii K, Kaijima M, Hirata Y, Saito M, Arai H, Japanese Society of Normal Pressure H (2012) Guidelines for management of idiopathic normal pressure hydrocephalus: second edition. Neurol Med Chir 52:775–809CrossRefGoogle Scholar
  15. 15.
    Muraki I, Yamagishi K, Ito Y, Fujieda T, Ishikawa Y, Miyagawa Y, Okada K, Sato S, Kitamura A, Shimamoto T, Tanigawa T, Iso H (2008) Caregiver burden for impaired elderly Japanese with prevalent stroke and dementia under long-term care insurance system. Cerebrovasc Dis 25:234–240CrossRefPubMedGoogle Scholar
  16. 16.
    Spagnoli D, Innocenti L, Bello L, Pluderi M, Bacigaluppi S, Tomei G, Gaini SM (2006) Impact of cerebrovascular disease on the surgical treatment of idiopathic normal pressure hydrocephalus. Neurosurgery 59:545–552, discussion 545–552CrossRefPubMedGoogle Scholar
  17. 17.
    Toma AK, Papadopoulos MC, Stapleton S, Kitchen ND, Watkins LD (2013) Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus. Acta Neurochir 155:1977–1980CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  • Masahiro Kameda
    • 1
    Email author
  • Shigeki Yamada
    • 2
  • Masamichi Atsuchi
    • 3
  • Teruo Kimura
    • 4
  • Hiroaki Kazui
    • 5
  • Masakazu Miyajima
    • 6
  • Etsuro Mori
    • 7
  • Masatsune Ishikawa
    • 2
  • Isao Date
    • 1
  • the SINPHONI and SINPHONI-2 Investigators
  1. 1.Department of Neurological SurgeryOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayama-ShiJapan
  2. 2.Normal Pressure Hydrocephalus Center, Department of Neurosurgery and Stroke CenterRakuwakai Otowa HospitalKyotoJapan
  3. 3.Department of NeurosurgeryAtsuchi Neurosurgical HospitalKagoshimaJapan
  4. 4.Department of NeurosurgeryDohtoh Neurosurgical HospitalHokkaidoJapan
  5. 5.Department of PsychiatryOsaka University Graduate School of MedicineOsakaJapan
  6. 6.Department of NeurosurgeryJuntendo University Graduate School of MedicineTokyoJapan
  7. 7.Department of Behavioral Neurology and Cognitive NeuroscienceTohoku University Graduate School of MedicineMiyagiJapan

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