Turkish Neurosurgery
Management of hardware related infections after DBS surgery: A cost analysis
Pim Wetzelaer2, Tim Bouwens van der Vlis1, Mehmet Tönge1, Linda Ackermans1, Pieter Kubben1, Silvia Evers3, Ersoy Kocabıçak4, Yasin Temel1
1Maastricht University Medical Center, Neurosurgery, Maastricht,
2Maastricht University, Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht,
3Maastricht University, Health Services Research, CAPHRI School of Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht,
4, Ondokuz Mayis University, 4. Department of Neurosurgery, Faculty of Medicine, Samsun,
DOI: 10.5137/1019-5149.JTN.21511-17.1

Aim:One of the most distressing hardware-related complications of deep brain stimulation is an infection. These infections can be either treated with antibiotics or with removal of the infected hardware followed by reimplantation. In our experience the success of antibiotic therapy was about 50%. Here, we have investigated the costs of treating the infection with antibiotics only with the risk of surgery when unsuccessful versus immediate removal followed by reimplantation.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 IPG replacement surgery were €29,301 and €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 an 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.

Corresponding author : Tim Bouwens van der Vlis