Management of hardware related infections after DBS surgery: A cost analysis

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Wetzelaer P., van der Vlis T. B., Tonge M., Ackermans L., Kubben P., Evers S., ...More

Turkish Neurosurgery, vol.28, no.6, pp.929-933, 2018 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 28 Issue: 6
  • Publication Date: 2018
  • Doi Number: 10.5137/1019-5149.jtn.21511-17.1
  • Journal Name: Turkish Neurosurgery
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, TR DİZİN (ULAKBİM)
  • Page Numbers: pp.929-933
  • Keywords: Complication, Cost, Deep brain stimulation, Hardware, Infection, Management
  • Istanbul Medipol University Affiliated: No


AIM: To investigate the costs of treating the infection with antibiotics only with the risk of surgery when unsuccessful versus immediate removal followed by re-implantation in patients with deep brain stimulation (DBS) hardware infection. 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 internal pulse generator (IPG) replacement surgery were €29,301 compared to €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 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.