{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T20:11:45Z","timestamp":1772050305006,"version":"3.50.1"},"reference-count":10,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2021,12,15]],"date-time":"2021-12-15T00:00:00Z","timestamp":1639526400000},"content-version":"unspecified","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Polyganics B.V.","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,11,25]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We aim to quantify the cost difference between patients with incisional cerebrospinal fluid (iCSF) leakage and those without after intradural cranial surgery. Second, the potential cost savings per patient when a decrease in iCSF leakage rate would be achieved with and without added costs for preventative measures of various price and efficacy are modelled.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Health economic assessment from a hospital perspective based on a retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Dutch tertiary referral centre.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>We included 616 consecutive patients who underwent intradural cranial surgery between 1 September 2017 and 1 September 2018. Patients undergoing burr hole surgery or transsphenoidal surgery, or who died within 1 month after surgery or were lost to follow-up were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Outcomes of the cost analysis include a detailed breakdown of mean costs per patient for patients with postoperative iCSF leakage and patients without, and the mean cost difference. For the scenario analyses the outcomes are the potential cost savings per 1000 patients when a decrease in iCSF leakage would be achieved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Mean cost difference between patients with and without iCSF leakage was \u20ac9665 (95%CI, \u20ac5125 to \u20ac14 205). The main cost driver was hospital stay with a difference of 8.5 days. A 25% incidence reduction would result in a mean cost saving of \u2212\u20ac94 039 (95% CI, \u2212\u20ac218 258 to \u2212\u20ac7077) per 1000 patients. A maximum cost reduction of \u2212\u20ac653 025 (95% CI, \u2212\u20ac1 204 243 to \u2212\u20ac169 120) per 1000 patients could be achieved if iCSF leakage would be reduced with 75% in all patients, with 72 cases of iCSF leakage avoided.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Postoperative iCSF leakage after intradural cranial surgery increases healthcare costs significantly and substantially. From a health economic perspective preventative measures to avoid iCSF leakage should be pursued.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-052553","type":"journal-article","created":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T11:31:26Z","timestamp":1639654286000},"page":"e052553","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Cerebrospinal fluid leakage costs after craniotomy and health economic assessment of incidence reduction from a hospital perspective in the Netherlands"],"prefix":"10.1136","volume":"11","author":[{"given":"Chris","family":"van Lieshout","sequence":"first","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4296-1331","authenticated-orcid":false,"given":"Emma M H","family":"Slot","sequence":"additional","affiliation":[{"name":"Neurology and Neurosurgery, University Medical Centre Utrecht Brain Centre, Utrecht, The Netherlands"},{"name":"Translational Neuroscience, University Medical Centre Utrecht Brain Centre, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmet","family":"Kinaci","sequence":"additional","affiliation":[{"name":"Neurology and Neurosurgery, University Medical Centre Utrecht Brain Centre, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mare H","family":"Kollen","sequence":"additional","affiliation":[{"name":"Neurology and Neurosurgery, University Medical Centre Utrecht Brain Centre, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eelco W","family":"Hoving","sequence":"additional","affiliation":[{"name":"Neurology and Neurosurgery, University Medical Centre Utrecht Brain Centre, Utrecht, The Netherlands"},{"name":"Neuro-oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geert W J","family":"Frederix","sequence":"additional","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tristan P C","family":"van Doormaal","sequence":"additional","affiliation":[{"name":"Neurology and Neurosurgery, University Medical Centre Utrecht Brain Centre, Utrecht, The Netherlands"},{"name":"Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,12,16]]},"reference":[{"key":"2025121602181708000_11.12.e052553.1","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.wneu.2018.06.196","article-title":"Effectiveness of dural sealants in prevention of cerebrospinal fluid leakage after craniotomy: a systematic review","volume":"118","author":"Kinaci","year":"2018","journal-title":"World Neurosurg"},{"key":"2025121602181708000_11.12.e052553.2","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1016\/j.surneu.2005.03.041","article-title":"Costs of postoperative cerebrospinal fluid leakage: 1-year, retrospective analysis of 412 consecutive nontrauma cases","volume":"64","author":"Grotenhuis","year":"2005","journal-title":"Surg Neurol"},{"key":"2025121602181708000_11.12.e052553.3","unstructured":"Hakkaart-van Rooijen L , Van der Linden N , Bouwmans CAM , et al . Manual for cost analyses, methods and standard prices for economic evaluations in healthcare. Diemen, The Netherlands: Zorginstituut Nederland, 2015."},{"key":"2025121602181708000_11.12.e052553.4","unstructured":"Nederlandse Zorgauthoriteit . Performance and Tariffs specialist medical care, 2017. Available: https:\/\/puc.overheid.nl\/doc\/PUC_21709_22\/1 [Accessed 3 Feb 2020]."},{"key":"2025121602181708000_11.12.e052553.5","doi-asserted-by":"crossref","first-page":"507","DOI":"10.2147\/CEOR.S112762","article-title":"A hospital cost analysis of a fibrin sealant patch in soft tissue and hepatic surgical bleeding","volume":"8","author":"Ferko","year":"2019","journal-title":"ClinicoEconomics and Outcomes Research"},{"key":"2025121602181708000_11.12.e052553.6","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.jval.2018.11.011","article-title":"Early assessment of Proof-of-Problem to guide health innovation","volume":"22","author":"Kluytmans","year":"2019","journal-title":"Value Health"},{"key":"2025121602181708000_11.12.e052553.7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4733.2008.00489.x"},{"key":"2025121602181708000_11.12.e052553.8","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1055\/s-0032-1304501","article-title":"Pharmacoeconomical consequences of postoperative CSF leaks after intracranial surgery--a prospective analysis","volume":"73","author":"Piek","year":"2012","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"key":"2025121602181708000_11.12.e052553.9","doi-asserted-by":"publisher","DOI":"10.3171\/2014.8.JNS132557"},{"key":"2025121602181708000_11.12.e052553.10","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1055\/s-0039-1679896","article-title":"Predictive factors, 30-day clinical outcomes, and costs associated with cerebrospinal fluid leak in pituitary adenoma resection","volume":"81","author":"Parikh","year":"2020","journal-title":"J Neurol Surg B Skull Base"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-052553","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T10:19:05Z","timestamp":1765880345000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-052553"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":10,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,16]]},"published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.1136\/bmjopen-2021-052553"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-052553","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]}}}