Clinical and health economic impact of the BASICS trial on ventriculoperitoneal shunt surgery: UK shunt registry analysis

The aim of this study was to determine the clinical and health economic impact of the British Antibiotic and Silver Impregnated Catheters for ventriculoperitoneal Shunts (BASICS) trial on UK shunt surgery practice and shunt infection rates. This retrospective study used UK Shunt Registry data to compare antibiotic and standard shunt use in patients undergoing the first insertion of a ventriculoperitoneal shunt during pre-BASICS (January 2004 to June 2013) and post-BASICS (January 2018 to December 2021) periods. Patients of any age with hydrocephalus who underwent a primary ventriculoperitoneal shunt insertion were included. The percentage of antibiotic shunts inserted was the primary outcome, and the revision rate for infection was the secondary outcome. A budget impact analysis was performed to estimate the cost savings from reduced shunt infection. Across the study period, 12,476 patients (22% pediatric patients) underwent primary shunt insertions with 1226 revisions across 36 centers. Antibiotic shunt use increased from 36.9% in pediatric patients and 20.5% in adults in 2004, to 99.2% in pediatric patients and 96.8% in adults in 2021. The largest change was from 2018 to 2019 (year of BASICS reporting), with a 14.9% and 27.2% increase for pediatric and adult patients, respectively. Compared with standard shunts, the infection rate for antibiotic shunts was significantly lower in both pediatric (5.1% vs 1.9%, p < 0.001) and adult (1.5% vs 0.9%, p = 0.031) patients. Antibiotic shunts saved the NHS an estimated £1,004,572 (95% CI £738,496-£1,270,648) per year. BASICS has been followed by evident change in UK neurosurgical practice. Antibiotic shunts are the first choice for patients, with reduced infection and cost savings of approximately £1 million per year.