Clinical outcomes and cost-utility analysis of programmable versus non-programmable ventriculoperitoneal shunts in communicating hydrocephalus: A population-based study.

OBJECTIVE

This study evaluated the clinical outcomes and cost-utility of programmable versus non-programmable ventriculo-peritoneal (VP) shunts in patients with communicating hydrocephalus.

METHODS

Patients who underwent VP shunt surgery at three major medical centers in Taiwan were included. Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics between 1,161 patients receiving programmable shunts and 1,061 receiving non-programmable shunts. Cox regression analyses were conducted to compare shunt revision, complication, and mortality rates. Cost-utility was assessed using a Markov decision-analytic model constructed from a healthcare provider perspective, incorporating a 1-year cycle length, a 10-year time horizon, and a 2% annual discount rate for both costs and effectiveness.

RESULTS

No significant differences were observed in shunt revision, complication, or mortality rates between the two groups. The cost-utility analysis demonstrated that programmable shunts yielded lower total costs (US$55,482.03 vs. US$63,176.72) and higher quality-adjusted life years (QALYs) (6.03 vs. 5.48). The incremental cost-utility ratio (ICUR) was -US$13,889.09/QALYs, indicating dominance of the programmable shunt strategy. At a willingness-to-pay threshold equivalent to one gross domestic product (GDP) per capita, programmable shunts could generate potential savings of US$69.4 million over 10 years, with an estimated net saving of approximately US$57 million after accounting for additional device costs.

CONCLUSIONS

Programmable VP shunts demonstrated superior cost-effectiveness and comparable clinical outcomes relative to non-programmable devices. These findings support the clinical and economic value of programmable shunts and provide evidence to inform policy decisions and shared decision-making in hydrocephalus management.