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Kim SJ, Nang QG, RoyChoudhury A, Kern AJM, Sheth K, Jacobs M, Poppas DP, Akhavan A. Cost comparison of intra-detrusor injection of botulinum toxin versus augmentation cystoplasty for refractory neurogenic detrusor overactivity in children. J Pediatr Urol 2022; 18:314-319. [PMID: 35216926 DOI: 10.1016/j.jpurol.2022.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 01/07/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Treatment options for refractory neurogenic detrusor overactivity (NDO) in children include botulinum toxin type A (BTX-A) and augmentation cystoplasty (AC). Although BTX-A is accepted in contemporary pediatric urologic practice, cost and long-term outcomes data for BTX-A are limited relative to the gold standard, AC. The purpose of this study was to compare the projected 10-year costs of AC versus BTX-A. METHODS We performed a cost analysis from the payer perspective by computationally modeling treatment sequences by a Markov model. In the model, we used probabilities derived from published sources, and costs obtained at a tertiary medical center. The base case was a pediatric patient with refractory NDO. In the model, we assumed biannual BTX-A treatments. Treatment costs over 10 years were compared between immediate AC versus bridging therapy with BTX-A. Using the computational model, we simulated 100,000 instances of 10-year treatment cost for each of the two treatment modalities. The costs for the two treatment approaches were then compared using t-test and Wilcoxon test. RESULTS The projected median and mean 10-year cost of immediately AC were $51,798.72 (95% CI [$51,798.72, $327,483.80]) and $123,473.4 (SD: $98,085.23) respectfully, while the projected median and mean 10-year cost of bridging therapy with BTX-A prior to proceeding to AC as needed were $74,552.46 (95% CI [$53,188.56, $309,913.07]) and $124,858.80 (SD: $84,495.35) (p < 0.001). CONCLUSIONS For a typical index pediatric patient with NDO, bridging therapy with intravesical BTX-A is associated with an increased cost compared to immediate AC over a ten-year period.
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Affiliation(s)
- Soo Jeong Kim
- Division of Pediatric Urology, Texas Children's Hospital, Houston, TX, USA
| | - Quincy G Nang
- Institute for Pediatric Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Arindam RoyChoudhury
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA
| | | | - Kunj Sheth
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Micah Jacobs
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Dix Phillip Poppas
- Institute for Pediatric Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Ardavan Akhavan
- Institute for Pediatric Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
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Pindrik J, Riva-Cambrin J, Kulkarni AV, Alvey JS, Reeder RW, Pollack IF, Wellons JC, Jackson EM, Rozzelle CJ, Whitehead WE, Limbrick DD, Naftel RP, Shannon C, McDonald PJ, Tamber MS, Hankinson TC, Hauptman JS, Simon TD, Krieger MD, Holubkov R, Kestle JRW. Surgical resource utilization after initial treatment of infant hydrocephalus: comparing ETV, early experience of ETV with choroid plexus cauterization, and shunt insertion in the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr 2020; 26:337-345. [PMID: 32559741 DOI: 10.3171/2020.4.peds19632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Few studies have addressed surgical resource utilization-surgical revisions and associated hospital admission days-following shunt insertion or endoscopic third ventriculostomy (ETV) with or without choroid plexus cauterization (CPC) for CSF diversion in hydrocephalus. Study members of the Hydrocephalus Clinical Research Network (HCRN) investigated differences in surgical resource utilization between CSF diversion strategies in hydrocephalus in infants. METHODS Patients up to corrected age 24 months undergoing initial definitive treatment of hydrocephalus were reviewed from the prospectively maintained HCRN Core Data Project (Hydrocephalus Registry). Postoperative courses (at 1, 3, and 5 years) were studied for hydrocephalus-related surgeries (primary outcome) and hospital admission days related to surgical revision (secondary outcome). Data were summarized using descriptive statistics and compared using negative binomial regression, controlling for age, hydrocephalus etiology, and HCRN center. The study population was organized into 3 groups (ETV alone, ETV with CPC, and CSF shunt insertion) during the 1st postoperative year and 2 groups (ETV alone and CSF shunt insertion) during subsequent years due to limited long-term follow-up data. RESULTS Among 1090 patients, the majority underwent CSF shunt insertion (CSF shunt, 83.5%; ETV with CPC, 10.0%; and ETV alone, 6.5%). Patients undergoing ETV with CPC had a higher mean number of revision surgeries (1.2 ± 1.6) than those undergoing ETV alone (0.6 ± 0.8) or CSF shunt insertion (0.7 ± 1.3) over the 1st year after surgery (p = 0.005). At long-term follow-up, patients undergoing ETV alone experienced a nonsignificant lower mean number of revision surgeries (0.7 ± 0.9 at 3 years and 0.8 ± 1.3 at 5 years) than those undergoing CSF shunt insertion (1.1 ± 1.9 at 3 years and 1.4 ± 2.6 at 5 years) and exhibited a lower mean number of hospital admission days related to revision surgery (3.8 ± 10.3 vs 9.9 ± 27.0, p = 0.042). CONCLUSIONS Among initial treatment strategies for hydrocephalus, ETV with CPC yielded a higher surgical revision rate within 1 year after surgery. Patients undergoing ETV alone exhibited a nonsignificant lower mean number of surgical revisions than CSF shunt insertion at 3 and 5 years postoperatively. Additionally, the ETV-alone cohort demonstrated significantly fewer hospital admission days related to surgical management of hydrocephalus within 3 years after surgery. These findings suggest a time-dependent benefit of ETV over CSF shunt insertion regarding surgical resource utilization.
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Affiliation(s)
- Jonathan Pindrik
- 1Division of Pediatric Neurosurgery, Department of Neurological Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jay Riva-Cambrin
- 2Section of Pediatric Neurosurgery, Division of Neurosurgery, Alberta Children's Hospital, University of Calgary, Alberta, Canada
| | - Abhaya V Kulkarni
- 3Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Jessica S Alvey
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Ron W Reeder
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Ian F Pollack
- 5Department of Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John C Wellons
- 6Division of Pediatric Neurosurgery, Department of Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric M Jackson
- 7Department of Neurosurgery, Johns Hopkins Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Curtis J Rozzelle
- 8Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama School of Medicine, Birmingham, Alabama
| | - William E Whitehead
- 9Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - David D Limbrick
- 10Division of Pediatric Neurosurgery, Departments of Neurological Surgery and Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, Missouri
| | - Robert P Naftel
- 6Division of Pediatric Neurosurgery, Department of Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chevis Shannon
- 6Division of Pediatric Neurosurgery, Department of Neurosurgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Patrick J McDonald
- 11Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mandeep S Tamber
- 11Division of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Todd C Hankinson
- 12Departments of Neurosurgery and Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Jason S Hauptman
- 13Division of Pediatric Neurosurgery, Department of Neurosurgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Tamara D Simon
- 13Division of Pediatric Neurosurgery, Department of Neurosurgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Mark D Krieger
- 14Department of Surgery, Children's Hospital of Los Angeles, California; and
| | - Richard Holubkov
- 15Hydrocephalus Clinical Research Network Data Coordinating Center, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - John R W Kestle
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
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Szentes T, Kovács L, Óváry C. New hospital structure in the twenty-first century: the position of level III (tertiary) neurological and stroke care in a changing healthcare system. SPRINGERPLUS 2016; 5:2039. [PMID: 27995016 PMCID: PMC5127917 DOI: 10.1186/s40064-016-3710-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 11/21/2016] [Indexed: 11/10/2022]
Abstract
AIM The determination of the necessary capacity and number of neurology wards of level III progressivity that can be defined in the system of criteria detailed in this article and which possess optimal operating conditions in Hungarian terms. METHODS We used the National Health Insurance Company's database to calculate case numbers and capacity for different levels of neurological and stroke care. We also revised the allocation of advanced diagnostic and therapeutic technologies, and proposed changes, based on health insurance data. We also discussed these propositions with clinical experts to test their viability. RESULTS We determined the adequate number of organisational units capable of providing special neurological healthcare services on the basis of the basic data of the Hungarian healthcare system, specifying this number as 6 instead of the current 11. CONCLUSIONS In our study, we have identified significant bias in the nationwide level of neurological and stroke care organisation, which needs revised allocation of healthcare resources. Naturally, this can only be carried out through the restructuring of the emergency care system and the expansion of pre-hospital care.
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Affiliation(s)
- Tamás Szentes
- National Healthcare Service Center, Budapest, Hungary
- National Public Health and Medical Officer Service, Budapest, Hungary
- Department of Public Health, Faculty of Medicine,, Semmelweis University, Budapest, Hungary
- ÁNTSZ Országos Tisztifőorvosi Hivatal, Albert Flórián út 2, 1097 Budapest, Hungary
| | | | - Csaba Óváry
- National Institute of Clinical Neurosciences, Budapest, Hungary
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