Antibiotic Impregnated External Ventricular Drains: Meta and Cost Analysis

• Published in: World neurosurgery 2016-02, Vol.86, p.306-315
• Main Authors: Root, Brandon K, Barrena, Benjamin G, Mackenzie, Todd A, Bauer, David F
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - economics; Anti-Bacterial Agents - therapeutic use; Antibiotic-impregnated; Catheters - economics; Cerebral Ventricles - surgery; Cerebrospinal Fluid Shunts; Cost-Benefit Analysis; Costs and Cost Analysis; Drainage - economics; Drainage - instrumentation; External ventricular drain; Hospital Costs; Humans; Infection; Meta-analysis; Neurosurgery; Observational Studies as Topic; Randomized Controlled Trials as Topic; Ventriculitis
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2015.09.032

Objective To determine whether antibiotic impregnated external ventricular drains (AI-EVDs) are effective in preventing ventriculostomy associated infection (VAI), and to examine their cost effectiveness. Methods A comprehensive literature search was performed for published data through May 2014, including randomized controlled trials and observational cohort studies comparing AI-EVDs with nonimpregnated controls. A meta-analysis of included studies was performed using a random effects model. Historical data at the authors' institution were used to estimate both the incremental price of AI-EVDs and the hospital expenses associated with VAI. Results Three randomized controlled trials and 5 observational studies met inclusion criteria. The analysis demonstrated a statistically significant protective effect of AI-EVDs against VAI (risk ratio = 0.31 [0.15–0.64]; P  = 0.002), although there was significant heterogeneity (χ2  = 18.08; P  = 0.01; I2  = 61%). The number of AI-EVDs needed to prevent one infection (Number needed to treat [NNT]) was 19. Based on $100 as the incremental price, and $30,000 as the estimated expense of one episode of VAI, AI-EVDs would result in an overall savings estimate of $28,100 (range, $26,400–$28,500) per NNT. If a hospital places 150 AI-EVDs annually, savings could range from $109,292 to $278,577 per year. Conclusions Meta-analysis demonstrated a significant protective benefit of AI-EVDs against VAI, and this benefit is likely associated with cost savings. However, current data on AI-EVDs are limited, and overall hospital costs will vary among institutions. Although both the efficacy and cost effectiveness of AI-EVDs are supported by this analysis, further study of AI-EVDs is clearly warranted.