Neurosurgeons say they are about to release guidelines to help primary care physicians identify patients with a neurologic disorder that could be treated with an implantable device at an estimated cost of $7 billion nationwide.
These costs are covered by Medicare, but they are much less than the cost of keeping patients with the disorder in nursing homes, the neurosurgeons add.
The guidelines are needed because the condition, known as normal pressure hydrocephalus (NPH), usually goes undiagnosed or is confused with other forms of dementia, says Anthony Marmarou, M.D., a neurosurgeon at Virginia Commonwealth University in Richmond, Va.
Marmarou says NPH involves the buildup of fluid in the brain cavities, crowding out brain tissue and disturbing brain functions. But he says 85% of an estimated 750,000 Americans with NPH can benefit from a shunt that drains the fluids.
The shunt, manufactured by several companies, including New Brunswick, N.J-based Johnson & Johnson, was first introduced five years ago but has been significantly updated in recent years, Marmarou and others say.
To install the shunt, the neurosurgeon drills a hole the size of a dime in the patient's skull. Plastic tubing is then drawn under the skin from the brain to a small incision in the stomach so the fluids can be drained.
Marmarou spoke to reporters Tuesday at the Neurologic and Orthopedic Institute of Chicago. He is chairman of an international group of neurosurgeons that recently completed new guidelines for identifying NPH and use of the shunt.
The guidelines, which have been submitted to several journals for publication, "will become the standard by which all doctors diagnose, treat and manage this condition," Marmarou says.
Key symptoms of NPH are impaired gait, dementia or incontinence, he says.
Marmarou says identifying patients for the shunt involves a three- to four-day hospital stay while the patient is given an external lumbar drain and observed.
Hospital officials say Medicare pays hospitals $9,860 to buy the shunt, determine whether the shunt should be used and install it. Medicare reimburses the physician $1,000 and pays $530 for an MRI, which is part of the work-up, they say, adding that Medicare reimbursement is much higher if the patient has complications.
Conservatively estimated, those charges add up to more than $11,000. Multiplied by an estimated 637,000 patients who would qualify for the shunt, that would amount to some $7 billion.
But Marmarou noted that without the treatment, patients typically enter nursing homes, where care costs $60,000 a year, or at least $38 billion a year for the same group of patients.