Analysis of the Cost-Effectiveness of Dural Sealants in the Endoscopic Repair of CSF Leaks

Document Type

Conference Proceeding

Publication Date


Publication Title

Journal of Neurological Surgery, Part B Skull Base


Objectives: Various synthetic and autologous grafting materials are commercially available for endoscopic repair of CSF leaks. The objective of our study was to use a cost effectiveness model to look at the efficacy of dural sealants during endoscopic repairs of CSF leak.

Methods: A decision tree was constructed to determine the incremental cost effectiveness ratio (ICER) of endoscopic repair with versus without use of dural sealants. We then performed a sensitivity analysis to calculate what the maximum cost of dural sealants would have to be to justify their effectiveness.

Results: Decision tree analysis shows that the overall cost of endoscopic CSF leak repair is $15,818 without and $16,920 with sealants. The best estimate of the incremental cost effectiveness ratio (ICER) of using sealants was $8.6 million per QALY gained, which is well above the $50,000/QALY willingness-to-pay (WTP) threshold. A cost-effectiveness acceptability curve demonstrated (CEAC) that dural sealants are not cost effective at an ICER of $8.6 million per QALY.

Conclusion: These data suggest that the routine use of dural sealants in endoscopic CSF leak repair does not represent a cost-effective practice at a willingness to pay threshold of $50,000/QALY. Further clinical evaluation exploring this issue may be invaluable in further identifying the appropriate role of dural sealants for this purpose.




Suppl 1


North American Skull Base Society 32nd Annual Meeting, February 17-19, 2023, Tampa, FL