PMD29 - Economic impact derived from the use of a catheter impregnated with Antibiotic in pediatric patients with hydrocephalus treated with external shunts in Mexico

Abstract

Estimate the economic impact derived from the use of antibiotic-impregnated catheters vs. traditional, non-antibiotic-impregnated catheters for the treatment of hydrocephalus in pediatric patients with external shunts from a Mexican public hospital perspective (IMSS). An Excel-based decision tree was used to estimate the economic consequences of using an antibiotic-impregnated catheter (treatment group) vs. a catheter without antibiotic (control group) for target population. Given procedure volume variability in comparable hospitals, base-case scenario assumed 100 pediatric patients with hydrocephalus and only one potential infection after first catheter placement; the antibiotic-impregnated device was assumed as second-line treatment for both groups. Infection rates after catheter placement for considered alternatives were taken from published international meta-analyses (2.4% vs. 8.7% for treatment and control groups, respectively). Unitary costs were provided by internal resources (antibiotic-impregnated device) and by public bid results for base-case hospital (traditional catheter). Considered time horizon was <1 year, thus no annual discount rate for costs was necessary. Inflation-adjusted DRGs from IMSS´s high specialty hospitals were used as hospitalization (catheter placement) and catheter replacement costs. Results are shown in 2015-adjusted USD. Due to low reinfection rates documented in literature, posterior infections and mortality were not considered. The total cost of the catheter with antibiotic strategy resulted in $1,610,600, while the non-antibiotic catheter strategy in $1,542,200, resulting in additional $684 per patient treated with the antibiotic-impregnated device and $11,400 per avoided infection. The use of antibiotic-impregnated catheters appears to be a cost-effective alternative to treat hydrocephalus in pediatric patients in the Mexican setting. Local high-specialty hospitals should consider the adoption of this alternative as it yields less infections in target population.