ABSTRACT
Purpose
This study aimed to evaluate the cost-effectiveness of a porcine-derived fibrin sealant
(PFS) for treating cerebrospinal fluid (CSF) leaks in cranial surgery compared with
sutures alone from the perspective of public hospital management in China.
Methods
A decision tree model of cranial surgery patients with intraoperative CSF leak was
constructed in R 3.6.3. The cost-effectiveness of using PFS with dural sutures was
compared versus using sutures alone. Efficacy and safety data were obtained from a
randomized controlled, single-blinded clinical trial that enrolled 200 patients (NCT03110783).
Effectiveness was measured as the success rate of CSF leak treatment and the rate
of postoperative complication. Hospital procurement costs were used to provide cost
measurements from the hospital administrator's perspective.
Findings
The PFS strategy had a higher success rate of CSF leak treatment (97.81% vs 49.21%)
and a lower complication rate (9.49% vs 14.29%), based on results from the clinical
trial. Using PFS also resulted in cost savings amounting to $374.97 in additional
intraoperative CSF leak repairs ($18.07 vs $393.04) and $66.68 in postoperative complication
treatment ($131.90 vs $198.58). Both one-way sensitivity analysis and probabilistic
sensitivity analysis confirmed that the model results were stable against input variations.
Implications
The decision tree analysis revealed that using PFS in conjunction with sutures was
associated with improved clinical performance and lower overall costs. PFS in combination
with sutures is the dominant strategy for treating CSF leak from the perspective of
hospital decision-makers.
Keywords
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Article info
Publication history
Published online: April 19, 2022
Accepted:
February 22,
2022
Identification
Copyright
© 2022 Elsevier Inc.
