{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T19:28:53Z","timestamp":1751398133864},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,11,28]],"date-time":"2020-11-28T00:00:00Z","timestamp":1606521600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec><jats:title>Background and purpose<\/jats:title><jats:p>Idiopathic normal\u2010pressure hydrocephalus (iNPH) is a progressive, severe brain disorder, which mainly affects people above the age of 65 years. iNPH is characterized by the accumulation of excess cerebrospinal fluid in the brain's ventricles. In most cases, iNPH patients can be effectively treated with shunt surgery, which involves placing a tube into the brain to drain the excess fluid. As part of the European Brain Council\u2010led Value of Treatment project, this study aimed to investigate the cost\u2010effectiveness of delivering timely and adequate iNPH treatment in Germany.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study identified treatment gaps that prevent iNPH patients from receiving adequate and timely treatment. The cost\u2010effectiveness of delivering shunt surgery to iNPH\u2010prevalent patients aged \u226565 years in Germany was calculated using decision\u2010analytical modelling. The model compared two alternatives, current care (shunt surgery in 25% of iNPH cases) and target care (shunt surgery in 90% of iNPH cases), and looked at healthcare costs (diagnosis, shunt intervention and follow\u2010up care) from the public health insurance perspective, as well as effectiveness outcomes in terms of lives saved and quality\u2010adjusted life\u2010years (QALYs) gained.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Delivering timely and adequate iNPH treatment proved to be cost\u2010effective. Cost per life saved varied between \u20ac27\u00a0921 at 5\u00a0years and \u20ac246\u00a0726 at 15\u00a0years. Cost\u2010per\u2010QALY estimates varied between \u20ac10\u00a0202 at 5\u00a0years and \u20ac35\u00a0128 at 15\u00a0years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Idiopathic normal\u2010pressure hydrocephalus is a treatable but often not\u2010treated disease, resulting in unnecessary and avoidable disease burden for the healthcare system. Actions required to close this treatment gap are straightforward and their implementation has been modelled with successful outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.14581","type":"journal-article","created":{"date-parts":[[2020,10,12]],"date-time":"2020-10-12T16:39:18Z","timestamp":1602520758000},"page":"681-690","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Idiopathic normal\u2010pressure hydrocephalus: the cost\u2010effectiveness of delivering timely and adequate treatment in Germany"],"prefix":"10.1111","volume":"28","author":[{"given":"M.","family":"Tinelli","sequence":"first","affiliation":[{"name":"Care Policy and Evaluation Centre London School of Economics and Political Science London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N.","family":"Guldemond","sequence":"additional","affiliation":[{"name":"I.M. Sechenov First Moscow State Medical University Dept. of Public Health and Healthcare N.A. Semashko Moscow Russia"},{"name":"Leiden University Medical Center Dept of Public Health and Primary Care Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"U.","family":"Kehler","sequence":"additional","affiliation":[{"name":"Chefarzt Neurochirurgie Asklepios Klinik Altona European Association of Neurosurgical Societies Hamburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,11,28]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000342"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0217705"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.32.12.1358"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000168185.29659.C5"},{"volume-title":"Normal Pressure Hydrocephalus","year":"2014","author":"Fritsch M","key":"e_1_2_8_6_1"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/2333721416643702"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.3171\/2014.6.JNS132003"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-017-3115-2"},{"key":"e_1_2_8_10_1","first-page":"15","article-title":"The differential diagnosis and treatment of normal\u2010pressure hydrocephalus","volume":"109","author":"Unterberg A","year":"2012","journal-title":"Deutsch \u00c4rztebl Int"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-017-3394-7"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-00749-2"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.5334\/ijic.812"},{"key":"e_1_2_8_14_1","first-page":"342","article-title":"Economic evaluation using decision analytical modelling: design, conduct, analysis, and reporting","volume":"11","author":"Petrou S","year":"2011","journal-title":"BMJ"},{"key":"e_1_2_8_15_1","first-page":"15","article-title":"The differential diagnosis and treatment of normal\u2010pressure hydrocephalus","volume":"109","author":"Kiefer M","year":"2012","journal-title":"Dtsch Arztebl Int"},{"key":"e_1_2_8_16_1","first-page":"1","article-title":"Influence of shunt surgery on healthcare expenditures of elderly fee\u2010for\u2010service Medicare beneficiaries with hydrocephalus","volume":"17","author":"Williams MA","year":"2007","journal-title":"J Neurosurg"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.3171\/2014.6.JNS131211"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2017.01.013"},{"key":"e_1_2_8_19_1","unstructured":"LarsenHI.Comorbidity and vascular risk factors associated with idiopathic normal pressure hydrocephalus: The INPH\u2010CRasH Study. Ume\u00e5 University Medical Dissertations 2016."},{"key":"e_1_2_8_20_1","unstructured":"DRG list in Germany 201611. A lles \u00fcber Pflegestufe 0 1 2 & 3 (Stand: 2016).https:\/\/www.jedermann\u2010gruppe.de\/pflegestufen\u20101\u20102\u20103\/[Last visited July 2017]."},{"key":"e_1_2_8_21_1","unstructured":"Jedermann Gruppehttps:\/\/www.jedermann\u2010gruppe.de\/ 2016[Last visited July 2017]."},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1590\/1980-57642018dn13-020001"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-016-8097-0"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1227\/01.NEU.0000175724.00147.10"},{"key":"e_1_2_8_25_1","unstructured":"CoulterA CollinsA.Making shared decision\u2010making a reality. 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