Turkish Neurosurgery 2018 , Vol 28 , Num 6
Management of Hardware Related Infections after DBS Surgery: A Cost Analysis
Pim WETZELAER1,Tim Bouwens van der VLIS2,Mehmet TONGE2,Linda ACKERMANS2,Pieter KUBBEN2,Silvia EVERS3,Ersoy KOCABICAK2,4,Yasin TEMEL2
1Maastricht University, Faculty of Psychology and Neuroscience, Department of Clinical Psychological Science, Maastricht, The Netherlands
2Maastricht University Medical Center, Department of Neurosurgery, Maastricht, The Netherlands
3Maastricht University, Faculty of Health Medicine and Life Sciences, Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht, The Netherlands
4Ondokuz Mayis University, Faculty of Medicine, Department of Neurosurgery, Samsun, Turkey
DOI : 10.5137/1019-5149.JTN.21511-17.1 AIM: To investigate the costs of treating the infection with antibiotics only with the risk of surgery when unsuccessful versus immediate removal followed by re-implantation in patients with deep brain stimulation (DBS) hardware infection.

MATERIAL and METHODS: We calculated the costs of the different strategies through a standard costing procedure. A decision model has been applied to establish the average treatment cost per patient representative for a clinical setting where both strategies are employed. Subsequently, a sensitivity analysis has been performed to assess the influence of clinical assumptions regarding the effectiveness of antibiotics treatment on average treatment costs.

RESULTS: The costs of treating a case of DBS hardware infection with immediate internal pulse generator (IPG) replacement surgery were ?29,301 compared to ?9499 for successful antibiotic treatment. For antibiotic treatment followed by IPG replacement surgery the total costs were ?38,741. Antibiotic treatment alone was successful in 44% (4/9) of the included cases of DBS infection, resulting in average treatment costs per patient of ?25,745. Trying to resolve DBS hardware infections initially with antibiotics reduced treatment costs by 12.1%.

CONCLUSION: Treatment with antibiotics with the risk of a later removal when unsuccessful was a more valuable strategy in terms of costs when compared to immediate surgical intervention in cases of hardware-related infections in DBS surgeries. Keywords : Complication, Cost, Deep brain stimulation, Hardware, Infection, Management

Corresponding author : Tim Bouwens van der VLIS, tim.bouwens@mumc.nl