A Cost-benefit Analysis of Using Polyethylene Glycol Hydrogel Sealant versus Fibrin Glue as a Dural Sealant for Posterior Fossa Surgery in the United States

Abstract

Background: Cerebrospinal fluid (CSF) leaks are a well-known complication of posterior fossa neurosurgery. The use of dural repair adjuncts has been associated with fewer CSF leaks and subsequently, lower medical costs. Objectives: To determine if the use of polyethylene glycol hydrogel sealant (DuraSeal dural sealant system [DuraSeal]), resulted in cost savings in the United States compared to use of fibrin glue in posterior fossa neurosurgery based on a published study of these two products. Methods: Primary analysis was based on a published cohort study (100 patients per cohort). Adjustments were made to account for the longer follow-up time of the fibrin glue cohort to better capture the incidence of CSF leaks, pseudomeningocele, wound infection, and meningitis using additional data from the literature. Resource utilization was calculated from literature studies and confirmed with consultations from two practicing neurosurgeons. The effective time horizon was 19 months. Undiscounted Medicare payments were used to calculate unit costs from a payer’s perspective based on hospital stay, cost of sealant application, and cost of complications. One-way sensitivity analysis was used to examine changes in costs as a result of model input changes. Results: In the base case, the cost of the hospital stay for the original surgery, which excludes the cost of complications, dominated costs for both cohorts. On a per patient basis, the use of fibrin glue cost $1666 more than the use of DuraSeal. Sensitivity analysis showed that using lumbar drainage instead of operative repair for a CSF leak reduced cost savings to $680. Holding the incidence of CSF leaks constant for the fibrin glue cohort while increasing the incidence for the DuraSeal cohort by 50% or 300% resulted in cost savings of $1438 and $755, respectively. Conclusions: The results of this study demonstrate a positive, consistent cost-benefit of DuraSeal compared to fibrin glue based on a cohort study of real world patients who underwent posterior fossa neurosurgery.