The economic burden of ventriculoperitoneal shunt insertion and its complications: Findings from a cohort in the Philippines

Introduction: Ventriculoperitoneal shunt (VPS) insertion is the gold standard treatment for congenital hydrocephalus, but there is little data about the cost of this procedure in developing countries. We aimed to determine the in-hospitalization cost of initial VPS insertion and its complications - shunt malfunction and infection – and identify predictors for cost.

Methods: We performed a retrospective cohort study by reviewing the medical and financial records of patients aged 18 years and below with a diagnosis of congenital hydrocephalus and underwent shunt surgery at our institution between 2015-2019. We also performed multivariable linear regression analysis to determine clinical characteristics that were predictive of cost.

Results: A total of 230 cerebrospinal fluid diversion procedures were performed on 125 patients. The mean age during index VPS insertion was 9.8 months (range: 7 days - 8 years). Fifteen patients (12%) developed shunt malfunction while 25 (20%) had a shunt infection. The mean in-hospitalization cost for all patients was PHP 94,573.50 (USD 1815.23). The predictors of higher cost found to be significant on both uni- and multivariable linear regression included (1) shunt infection (p < 0.001), (2) shunt malfunction (p < 0.001), (3) pneumonia (p=0.006), (4) sepsis (p=0.004), and (5) length of hospital stay (p=0.005). Patients complicated by shunt infection had a higher mean cost (PHP 282,631.60 or USD 5424.79) than uncomplicated patients (PHP 40,587.20 or USD 779, p< 0.001) and patients who had shunt malfunction (PHP 87,065.70 or 167.13, p< 0.001).

Conclusion : This study describes the cost of VPS insertion for congenital hydrocephalus in a public hospital in the Philippines, and the management of shunt complications – particularly, infection and malfunction. We found modifiable risk factors predictors of cost, including shunt infection, malfunction, pneumonia, sepsis, and length of stay. These can be potential targets of improvement initiatives to favorably affect health outcomes and reduce costs.