The Amphitheater
On-line Lectures

Potential Cost of Non-Invasive Telemetric Monitoring in Patients with Shunted Hydrocephalus

David M.Frim, M.D., Ph.D., Marc S. Schwartz, M.D., Joseph R. Madsen, M.D.

Section of Neurosurgery, Wyler Children's Hospital and The University of Chicago, Chicago, Illinois; Department of Neurosurgery, Children's Hospital and Harvard Medical School, Boston, Massachusetts

Correspondence:
David M. Frim, M.D.
University of Chicago
Section of Neurosurgery, MC-3026
5841 South Maryland Avenue
Chicago, Illinois 60637
Ph: (312) 702-2475

Abstract

Current reality in health care financing mandates a continued search for cost effective management strategies in neurosurgery. The use of non-invasive telemetric monitoring for measurement of intraventricular pressure (IVP) in the shunted patient has never been shown to have cost advantage over standard approaches to the evaluation of shunt malfunction. We have had opportunity to implant TeleSensor monitors (Radionics) in four patients with symptomatic shunted hydrocephalus and a fifth with ventriculomegaly at the time of repair of a post-traumatic leptomeningeal cyst. Office and Emergency Department (ED) visits were prospectively recorded as were the number of times the TeleSensor was monitored and the number of cranial CT scans performed. We found that telemetric monitoring was performed at an average of 2.4 times within the first eight months post implantation (range 2 to 5) and that patients underwent CT scanning on average 1.2 times during that period. Eight instances of monitored telemetry directly shortened or obviated the need for ED evaluation and CT scanning at an estimated cost savings of $6000.00 for the five patients ($1200/patient) over the study period. We have extrapolated this incidence to an ongoing clinical protocol data set for shunt malfunction at our institution and found that universal implantation of telemetric monitoring devices could result in an average cost savings of approximately $85.00 per patient presenting for evaluation of shunt malfunction per month. We conclude that implantation of telemetric monitors of intraventricular pressure is cost-effective for shunted patients that remain symptomatic and difficult to manage. In addition, cost analysis invites consideration of universal implantation of non-invasive intraventricular pressure monitoring devices in shunted patients.

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