Analysis of the Cost-Effectiveness of Dural Sealants in the Endoscopic Repair of CSF Leaks
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.
Johnson J, Casiano R, Sargi Z, Levine C, Folbe A. Analysis of the cost-effectiveness of dural sealants in the endoscopic repair of CSF leaks. J Neurol Surg B Skull Base. 2023 Feb;84(Suppl 1). doi:10.1055/s-0043-1762271