Abstract
BackgroundThe objective was to evaluate the cost-effectiveness of shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH).MethodsHealth-related quality of life was evaluated before and 6 months after surgery using the EQ-5D-3 L (EuroQOL group five-dimensions health survey) in 30 patients (median age, 71 years; range, 65–89 years) diagnosed with iNPH. The costs associated with shunt surgery were assessed by a detailed survey with interviews and extraction of register data concerning the cost of hospital care, primary care, residential care, home-care service and informal care. The cost of untreated patients was derived from the cost of dementia disorders in Sweden in 2012, as reported by the National Board of Health and Welfare. The cost effectiveness analysis used a decision-analytic Markov model. We used a societal perspective and a lifelong time horizon to estimate costs and effects. One-way sensitivity analysis and probabilistic sensitivity analysis were carried out to test the robustness of the model.ResultsThe shunt surgery model as the standard treatment in iNPH resulted in a gain of 2.2 life years and 1.7 quality-adjusted life years (QALY), along with an incremental cost per patient of €7,500/QALY. The sensitivity analysis showed that the results were not sensitive to changes in uncertain parameters or assumptions.ConclusionsShunt surgery in iNPH, an underdiagnosed condition severely impairing elderly patients, is not only an effective medical treatment, it is also cost-effective, adding 2.2 additional life years and 1.7 QALYs at a low cost, a remarkable gain for an individual aged around 70 years.
Highlights
Idiopathic normal pressure hydrocephalus is a treatable gait disorder and one of very few treatable causes of dementia, most often causing balance and urinary disturbances [25]
The cost effectiveness of treating idiopathic normal pressure hydrocephalus (iNPH) has not been investigated in a prospective study with patient experienced QoL and cost data, and the aim of the present study was to investigate this from a societal perspective, using a decisionanalytic Markov model adapted to Swedish circumstances
The lifelong cost-effectiveness model showed that shunt surgery resulted in a gain in both life years saved and qualityadjusted life years (QALY) of the simulated cohort, compared with natural history patients (Fig. 3)
Summary
Idiopathic normal pressure hydrocephalus (iNPH) is a treatable gait disorder and one of very few treatable causes of dementia, most often causing balance and urinary disturbances [25]. Treatment by shunt surgery is effective with substantial clinical improvement in up to 80% of the patients [4, 25, 43]. Health-related quality of life (HRQoL) is lower in iNPH patients than in age-matched healthy individuals [19, 31], but improves in 86% of patients after surgery to almost the same level as in the normal population [31]. The objective was to evaluate the costeffectiveness of shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH). Methods Health-related quality of life was evaluated before and 6 months after surgery using the EQ-5D-3 L (EuroQOL group five-dimensions health survey) in 30 patients (median age, 71 years; range, 65–89 years) diagnosed with iNPH. One-way sensitivity analysis and probabilistic sensitivity analysis were carried out to test the robustness of the model
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