Shunts in normal-pressure hydrocephalus: do we place too many or too few?

Abstract:

OBJECT:The average 65-year-old patient with moderate dementia can look forward to only 1.4 quality-adjusted life years (QALYs), that is, longevity times quality of life. Some of these patients suffer from normal-pressure hydrocephalus (NPH) and respond dramatically to shunt insertion. Currently, however, NPH cannot be diagnosed with certainty. The authors constructed a Markov decision analysis model to predict the outcome in patients with NPH treated with and without shunts. METHODS:Transition probabilities and health utilities were obtained from a review of the literature. A sensitivity analysis and Monte Carlo simulation were applied to test outcomes over a wide range of parameters. Using shunt response and complication rates from the literature, the average patient receiving a shunt would gain an additional 1.7 QALYs as a result of automatic shunt insertion. Even if 50% of patients receiving a shunt have complications, the shunt response rate would need to be less than 5% for empirical shunt insertion to do more harm than good. Authors of most studies have reported far better statistics. CONCLUSIONS:In summary, many more patients with suspected NPH should be considered for shunt insertion.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Stein SC,Burnett MG,Sonnad SS

doi

10.3171/jns.2006.105.6.815

subject

Has Abstract

pub_date

2006-12-01 00:00:00

pages

815-22

issue

6

eissn

0022-3085

issn

1933-0693

journal_volume

105

pub_type

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