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Cost-Effectiveness of Epilepsy Surgery

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Surgical Treatment of Epilepsies

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Abstract

Pharmacoresistant epilepsy represents a substantial burden for the health care system. It has been shown that the 20–30% of children and adults with medically refractory epilepsy add to 38% of annual direct and 86% of indirect medical costs of epilepsy. Another analysis noted that the 15% of patients who are most refractory amount to >50% of the total costs of epilepsy. Direct costs of medically intractable patients mainly related to antiepileptic drugs have been estimated to be 4–9 times higher than those for controlled epilepsy patients. Indirect costs due to lost work time are particularly important in epilepsy, since this disease affects young patients making them disabled during the most productive phase of their lives if not successfully treated. On the other hand, presurgical evaluation and surgical treatment are cost-intensive, too, requiring a highly specialized personnel and expensive equipment. Data available indicate that resective surgical treatment of drug-resistant epilepsy is cost-effective not only in the short term, but also in the long term, both for children and adults resulting in significant reduction of direct and indirect health care costs simulated over lifetime. Only scarce reports on cost-effectiveness of non-resective surgical modalities are available, results of which are not conclusive. Long-term controlled trials and modeling studies assessing different surgical strategies including standardized psychosocial and health quality measures are necessary to provide valid data on the cost-effectiveness of epilepsy surgical programs.

Economy is the wealth of the poor and the wisdom of the rich.

French Proverb

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References

  1. Berg AT, Shinnar S, Levy SR, Testa FM, Smith-Rapaport S, Beckerman B. Early development of intractable epilepsy in children: a prospective study. Neurology. 2001;56:1445–52.

    CAS  PubMed  Google Scholar 

  2. Farrell K, Wirrell E, Whiting S. The definition and prediction of intractable epilepsy in children. Adv Neurol. 2006;97:435–42.

    PubMed  Google Scholar 

  3. Thijs RD, Surges R, O’Brien TJ, Sander LW. Epilepsy in adults. Lancet. 2019;393:689–701.

    PubMed  Google Scholar 

  4. Kwan P, Brodie MJ. Early identification of refractory epilepsy. N Engl J Med. 2000;342(5):314–9.

    CAS  PubMed  Google Scholar 

  5. Engel J Jr. What can we do for people with drug-resistant epilepsy? The 2016 Wartenberg Lecture. Neurology. 2016;87(23):2483–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Englot DJ. A modern epilepsy surgery treatment algorithm: incorporating traditional and emerging technologies. Epilepsy Behav. 2018;80:68–74.

    PubMed  PubMed Central  Google Scholar 

  7. Begley CE, Famulari M, Annegers JF, et al. The cost of epilepsy in the United States: an estimate from population-based clinical and survey data. Epilepsia. 2000;41:342–51.

    CAS  PubMed  Google Scholar 

  8. Begley CE, Annegers JF, Lairson DR, Reynolds TF, Hauser WA. Cost of epilepsy in the United States: a model based on incidence and prognosis. Epilepsia. 1994;35:1230–43.

    CAS  PubMed  Google Scholar 

  9. Platt M, Sperling MR. A comparison of surgical and medical costs for refractory epilepsy. Epilepsia. 2002;43:25–31.

    PubMed  Google Scholar 

  10. Jennum P, Debes NMM, Ibsen R, Kjellberg J. Long-term employment, education, and healthcare costs of childhood and adolescent onset of epilepsy. Epilepsy Behav. 2020:107256. https://doi.org/10.1016/j.yebeh.2020.107256.

  11. Begley CE, Durgin TL. The direct cost of epilepsy in the United States: a systematic review of estimates. Epilepsia. 2015;56:1376–87.

    PubMed  Google Scholar 

  12. Jacoby A, Buck D, Baker G, McNamee P, Graham-Jones S, Chadwick D. Uptake and costs of care for epilepsy: findings from a U.K. regional study. Epilepsia. 1998;39:776–86.

    CAS  PubMed  Google Scholar 

  13. Langfitt JT, Holloway RG, McDermott MP, Messing S, Sarosky K, Berg AT, Spencer SS, Vickrey BG, Sperling MR, Bazil CW, Shinnar S. Health care costs decline after successful epilepsy surgery. Neurology. 2007a;68:1290–8.

    CAS  PubMed  Google Scholar 

  14. Langfitt JT, Holloway RG, McDermott MP, et al. Health care costs decline after successful epilepsy surgery. Neurology. 2007b;68:1290–8.

    CAS  PubMed  Google Scholar 

  15. Luoni C, Canevini MP, Capovilla G, et al. A prospective study of direct medical costs in a large cohort of consecutively enrolled patients with refractory epilepsy in Italy. Epilepsia. 2015;56:1162–73.

    PubMed  Google Scholar 

  16. Gao L, Xia L, Pan SQ, et al. Burden of epilepsy: a prevalence-based cost of illness study of direct, indirect and intangible costs for epilepsy. Epilepsy Res. 2015;110:146–56.

    PubMed  Google Scholar 

  17. Jennum P, Gyllenborg J, Kjellberg J. The social and economic consequences of epilepsy: a controlled national study. Epilepsia. 2011;52:949–56.

    PubMed  Google Scholar 

  18. Wilner AN, Sharma BK, Thompson A, et al. Diagnoses, procedures, drug utilization, comorbidities, and cost of health care for people with epilepsy in 2012. Epilepsy Behav. 2014;41:83–90.

    CAS  PubMed  Google Scholar 

  19. King JT Jr, Sperling MR, Justice AC, et al. A cost-effectiveness analysis of anterior temporal lobectomy for intractable temporal lobe epilepsy. J Neurosurg. 1997;87:20–8.

    PubMed  Google Scholar 

  20. Langfitt JT. Cost-effectiveness of anterotemporal lobectomy in medically intractable complex partial epilepsy. Epilepsia. 1997;2:154–63.

    Google Scholar 

  21. Malmgren K, Hedstrom A, Granqvist R, et al. Cost analysis of epilepsy surgery and of vigabatrin treatment in patients with refractory partial epilepsy. Epilepsy Res. 1996;25:199–207.

    CAS  PubMed  Google Scholar 

  22. Wiebe S, Gafni A, Blume WT, et al. An economic evaluation of temporal lobe epilepsy. Epilepsy. 1995;8:227–35.

    Google Scholar 

  23. Picot M-C, Jaussent A, Neveu D, Kahane P, Crespelle A, et al. Cost-effectiveness analysis of epilepsy surgery in a controlled cohort of adult patients with intractable partial epilepsy: a 5-year follow-up study. Epilepsia. 2016; https://doi.org/10.1111/epi.13492.

  24. Jennum P, Christensen J, Ibsen R, Kjellberg J. Long-term socioeconomic consequences and health care costs of childhood and adolescent-onset epilepsy. Epilepsia. 2016;57(7):1078–85.

    PubMed  Google Scholar 

  25. Jennum P, Sabers A, Christensen J, Ibsen R, Kjellberg J. Socioeconomic outcome of epilepsy surgery: a controlled national study. Seizure. 2016;42:52–6.

    PubMed  Google Scholar 

  26. Sheikh SR, Steinmetz MP, Kattan MW, et al. The cost-effectiveness of epilepsy surgery and surgical evaluation in the United States. Neurosurgery. 2019; https://doi.org/10.1093/neuros/nyz310_165.

  27. Keene D, Ventureyra EC. Epilepsy surgery for 5- to 18-year old patients with medically refractory epilepsy—is it cost efficient? Childs Nerv Syst. 1999;15(1):52–4. discussion 55

    CAS  PubMed  Google Scholar 

  28. Widjaja E, Li B, Schinkel CD, Ritchie LP, Weaver J, Snead OC, Rutka JT, Coyte PC. Cost-effectiveness of pediatric epilepsy surgery compared to medical treatment in children with intractable epilepsy. Epilepsy Res. 2011;94:61–8.

    PubMed  Google Scholar 

  29. Bowen JM, Snead OC, Chandra K, Blackhouse G, Goeree R. Epilepsy Care in Ontario: an economic analysis of increasing access to epilepsy surgery. Ont. Health Technol. Assess. Ser. 2012;12(18):1–41.

    PubMed  PubMed Central  Google Scholar 

  30. Oldham MS, Horn P, Tsevat J, Standridge S. Costs and clinical outcomes of epilepsy surgery in children with drug-resistant epilepsy. Pediatr Neurol. 2015. Doi: 10.10.16/j

    Google Scholar 

  31. Catchpool M, Dalziel K, Mahardya RTK, et al. Cost-effectiveness of epileptic surgery compared with medical treatment in children with drug-resistant epilepsy. Epilepsy Behav. 2019;97:253–9.

    PubMed  Google Scholar 

  32. Reid K, Herbert A, Baker G. Epilepsy surgery: patient-perceived long-term costs and benefits. Epilepsy Behav. 2004;5:81–7.

    PubMed  Google Scholar 

  33. Kellet MW, Smith DF, Baker GA, Chadwick DW. Quality of life after epilepsy surgery. J Neurol Neurosurg Psychiatry. 1997;63:52–8.

    Google Scholar 

  34. Wheelock I, Peterson C, Buchtel HA. Presurgery expectations, postsurgery satisfaction, and psychosocial adjustment after epilepsy surgery. Epilepsia. 1998;39:487–94.

    CAS  PubMed  Google Scholar 

  35. Berto P. Quality of life in patients with epilepsy and impact of treatments. PharmacoEconomics. 2000;20:1039–59.

    Google Scholar 

  36. Derry PA, McLachlan RS. Causal attributions for seizures: relation to preoperative psychological adjustment and postoperative psychosocial function in temporal lobe epilepsy. J Epilepsy. 1995;8:74–8.

    Google Scholar 

  37. Markand ON, Salanova V, Whelihan E, Emsley CL. Health- related quality of life outcome in medically refractory epilepsy treated with anterior temporal lobectomy. Epilepsia. 2000;41:749–59.

    CAS  PubMed  Google Scholar 

  38. McLachlan RS, Rose KJ, Derry PA, Bonnar C, Blume WT, Girvin JP. Health related quality of life and seizure control in temporal lobe epilepsy. Ann Neurol. 1997;41:482–91.

    CAS  PubMed  Google Scholar 

  39. Vickery BG, Hays RD, Rausch R, Engel J, Visscher BR, Ary CM. Quality of life of epilepsy surgery patients as compared with outpatients with hypertension, diabetes, heart disease, and/or depressive symptoms. Epilepsia. 1995;35:597–607.

    Google Scholar 

  40. Malmgren K, Edelvik A. Long-term outcomes of surgical treatment for epilepsy in adults with regard to seizures, antiepileptic drug treatment and employment. Seizure. 2017;44:217–24.

    Google Scholar 

  41. Lendt M, Helmstaedter C, Elger CE. Pre- and postoperative socioeconomic development of 151 patients with focal epilepsies. Epilepsia. 1997;38:1330–7.

    CAS  PubMed  Google Scholar 

  42. Derry P, Wiebe S. Psychological adjustment to success and to failure following epilepsy surgery. Can J Neurol Sci. 2000;27(Supp1):116–20.

    Google Scholar 

  43. Taylor DC. Patients´ aims for epilepsy surgery: desires beyond seizure freedom. Epilepsia. 2001;42:629–33.

    CAS  PubMed  Google Scholar 

  44. Sperling MR, Saykin AJ, Roberts FD, et al. Occupational outcome after temporal lobectomy for refractory epilepsy. Neurology. 1995;45(5):970–7.

    CAS  PubMed  Google Scholar 

  45. Vakharia VN, Duncan JS, Witt JA, et al. Getting the best outcomes from epilepsy surgery. Ann Neurol. 2018;83(4):676–90.

    PubMed  PubMed Central  Google Scholar 

  46. Hamiwka L, Macrodimitris S, Tellez-Zenteno JF, et al. Social out-comes after temporal or extratemporal epilepsy surgery: a systematic review. Epilepsia. 2011;52:870–9.

    PubMed  Google Scholar 

  47. Zarroli K, Tracy JI, Nei M, et al. Employment after anterior temporal lobectomy. Epilepsia. 2011;52:925–31.

    PubMed  Google Scholar 

  48. Thorbecke R, May TW, Koch-Stoecker S, Ebner A, Bien CG, Specht U. Effects of an inpatient rehabilitation program after temporal lobe epilepsy surgery and other factors on employment 2 years after epilepsy surgery. Epilepsia. 2014;55:725–33.

    PubMed  Google Scholar 

  49. Alonso NB, Mazetto L, de Araujo Filho GM, Vidal-Dourado M, Yacubian EM, Centeno RS. Psychosocial factors associated with in postsurgical prognosis of temporal lobe epilepsy related to hippocampal sclerosis. Epilepsy Behav. 2015;53:66–72.

    PubMed  Google Scholar 

  50. Andersson-Roswall L, Engman E, Samuelsson H, Malmgren K. Psychosocial status 10 years after temporal lobe resection for epilepsy, a longitudinal controlled study. Epilepsy Behav. 2013;28:127–31.

    PubMed  Google Scholar 

  51. Dupont S, Tanguy ML, Clemenceau S, Adam C, Hazemann P, Baulac M. Long-term prognosis and psychosocial outcomes after surgery for MTLE. Epilepsia. 2006;47:2115–24.

    PubMed  Google Scholar 

  52. Elsharkawy AE, May T, Thorbecke R, Koch-Stoecker S, Villagran A, Urak L, Pfafflin M, Pannek H, Pietila TA, Ebner A. Long-term outcome and determinants of quality of life after temporal lobe epilepsy surgery in adults. Epilepsy Res. 2009;86:191–9.

    PubMed  Google Scholar 

  53. Jennum P, Ibsen R, Kjellberg J. Social consequences of sleep disordered breathing on patients and their partners: a controlled national study. Eur Respir J. 2014;43:134–44.

    PubMed  Google Scholar 

  54. Bendix T, Kjellberg J, Ibsen R, Jennum PJ. Whiplash(−like) injury diagnoses and co- morbidities - both before and after the injury: a national registry-based study. BMC Musculoskelet Disord. 2016;17:24.

    PubMed  PubMed Central  Google Scholar 

  55. Puka K, Tavares T, Speechley K. Social outcomes for adults with a history of childhood-onset epilepsy: a systematic review and meta-analysis. Epilepsy Behav. 2019;92:297–305.

    PubMed  Google Scholar 

  56. Englot D, Birk H, Chang EF. Seizure outcomes in nonresective epilepsy surgery: an update. Neurosurg Rev. 2016;40(2):181–94.

    PubMed  PubMed Central  Google Scholar 

  57. Ben-Menachem E, Hellstrom K, Verstappen D. Analysis of direct hospital costs before and 18 months after treatment with vagus nerve stimulation therapy in 43 patients. Neurology. 2002;59:S44–7.

    PubMed  Google Scholar 

  58. Helmers SL, Duh MS, Guerin A, Sarda SP, Samuelson TM, Bunker MT, Olin BD, Jackson SD, Faught E. Clinical outcomes, quality of life, and costs associated with implantation of vagus nerve stimulation therapy in pediatric patients with drug- resistant epilepsy. Eur J Paediatr Neurol. 2012;16:449–58. https://doi.org/10.1016/j.ejpn.2012.01.001.

    Article  PubMed  Google Scholar 

  59. De Kinderen RJA, Postulart D, et al. Cost-effectiveness of the ketogenic diet and vagus nerve stimulation for the treatment of children with intractable epilepsy. Epilepsy Res. 2015;110:119–31.

    PubMed  Google Scholar 

  60. Langfitt JT, Quigg M, Yan G, et al. Direct and indirect costs associated with stereotactic radiosurgery or open surgery for medial temporal lobe epilepsy: results from the ROSE trial. Epilepsia. 2019;60:1453–61.

    PubMed  Google Scholar 

  61. Widjaja E, Papastavros T, Sander B, et al. Early economic evaluation of MRI-guided laser interstitial thermal therapy (MRgLITT) and epilepsy surgery for mesial temporal lobe epilepsy. PLoS One. 2019;14(11):e0224571. https://doi.org/10.1371/journal.pone.0224571.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Wiebe S, Rose K, Derry P, McLachlan R. Outcome assessment in epilepsy: comparative responsiveness of quality of life and psychosocial instruments. Epilepsia. 1997;38(4):430–8.

    CAS  PubMed  Google Scholar 

  63. Choi H, Sell RL, Lenert L, et al. Epilepsy surgery for pharmacoresistant temporal lobe epilepsy: a decision analysis. JAMA. 2008;300:2497–505.

    CAS  PubMed  Google Scholar 

  64. De Tisi J, Bell GS, Peacock JL, et al. The long-term outcome of adult epilepsy surgery, patterns of seizure remission, and relapse: a cohort study. Lancet. 2011;378:1388–95.

    PubMed  Google Scholar 

  65. Tellez-Zenteno JF, Dhar R, Wiebe S. Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis. Brain. 2005;128:1188–98.

    PubMed  Google Scholar 

  66. Schiltz NK, Kaiboriboon K, Koroukian SM, Singer MR, Love TE. Long-term reduction of health costs and utilization after epilepsy surgery. Epilepsia. 2016;57(2):316–24.

    PubMed  Google Scholar 

  67. Eliashiv S, Dewar S, Wainwright I, Engel J, Fried I. Long-term follow up after temporal lobe resection for lesions associated with chronic seizures. Neurology. 1997;48:621–6.

    CAS  PubMed  Google Scholar 

  68. Ewes RDC, Dunn G, Binnie CD, Polkey CE. Outcome following resective surgery for temporal lobe epilepsy: a prospective follow up study of 102 consecutive cases. J Neurol Neurosurg Psychiatry. 1991;54:949–52.

    Google Scholar 

  69. Spencer S. Long-term outcome after epilepsy surgery. Epilepsia. 1996;37:807–13.

    CAS  PubMed  Google Scholar 

  70. Coleman H, McIntosh A, Wilson SJ. Identifying the trajectory of social milestones 15-20 years after epilepsy surgery: realistic timelines for postsurgical expectations. Epilepsiy. 2019; https://doi.org/10.1002/epi4.12341.

  71. Dlugos DJ. The early identification of candidates for epilepsy surgery. Arch Neurol. 2001;58:1543–6.

    CAS  PubMed  Google Scholar 

  72. Strzelczyk A, Reese JP, Dodel R, Hamer HM. Cost of epilepsy: a systematic review. Pharmaceconomics. 2008;26(6):463–76.

    Google Scholar 

  73. Redelmeier D, Fuchs V. Hospital expenditures in the United States and Canada. N Engl J Med. 1993;328:772–8.

    CAS  PubMed  Google Scholar 

  74. Langfitt JT, Vickrey BG, McDermott M, et al. Validity & responsiveness of generic preference-based HRQOL instruments in chronic epilepsy. Qual Life Res. 2006;15:899–914.

    CAS  PubMed  Google Scholar 

  75. Jacoby A, Austin JK. Social stigma for adults and children with epilepsy. Epilepsia. 2007;48:6–9.

    PubMed  Google Scholar 

  76. Rossi GF. Evaluation of surgical treatment outcome in epilepsy. Crit Rev Neurosurg. 1998;8:282–9.

    CAS  PubMed  Google Scholar 

  77. Sadanand V. Economics of epilepsy surgery. Ann Indian Acad Neurol. 2014;17(Suppl. 1):S120–3.

    PubMed  PubMed Central  Google Scholar 

  78. Sheikh SR, Thompson N, Frech F, et al. Quantifying the burden of generalized tonic-clonic seizures in patients with drug-resistant epilepsy. Epilepsia. 2020; https://doi.org/10.1111/epi.16603.

  79. Ashenfelter O. Measuring the value of statistical life: problems and prospects. Econ. 2006;116:10–23.

    Google Scholar 

  80. Viscusi WK, Aldy JE. The value of a statistical life: a critical review of market estimates throughout the world. J Risk Uncert. 2003;27:5–76.

    Google Scholar 

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    Josef Zentner

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Zentner, J. (2020). Cost-Effectiveness of Epilepsy Surgery. In: Surgical Treatment of Epilepsies. Springer, Cham. https://doi.org/10.1007/978-3-030-48748-5_16

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