Dataset Information

Hospital costs associated with vagus nerve stimulation and medical treatment in pediatric patients with refractory epilepsy.

ABSTRACT:

Objectives

Refractory epilepsy is a diagnosis of recurrent seizures that requires multiple resources for optimal chronic management. The disease negatively impacts the lives of affected patients and families and poses an economic burden to the health care system. This study compares hospital costs between pediatric patients treated with antiseizure medications (ASMs) only and ASMs plus vagus nerve stimulation (VNS).

Methods

Patients 0-17 years of age who were diagnosed with refractory epilepsy between January 1, 2011 and December 31, 2016, were identified from the Children's Hospital Association's Pediatric Health Information System (PHIS) database. Patients treated with ASMs only or ASMs plus VNS were included in the study and were followed 1 year prior and 2 years after meeting pre-determined criteria for refractory epilepsy. The difference-in-difference (DID) approach along with the two-part model was used to compare the changes in mean hospital costs captured in the PHIS database over time between the two cohorts.

Results

One thousand one hundred thirteen patients treated with ASMs plus VNS and 3471 patients treated with ASMs only were included. At a follow-up time of 2 years, for the ASMs-only cohort, the adjusted all-cause and epilepsy-related mean annual total costs increased by $14 715 (95% confidence interval [CI]: $12 375-$17 055) and $18 437 (95% CI: $15 978-$20 896), respectively. By comparison, the adjusted all-cause and epilepsy-related mean annual total costs of the ASMs plus VNS cohort increased by $12 838 (95% CI: $8171-$17 505) and $15 183 (95% CI: $10 253-$20 113), respectively. Compared to ASMs only, ASMs plus VNS generated a cost savings of $3254 for epilepsy-related annual costs per year after the index date.

Significance

Compared to ASMs alone, ASMs plus VNS is a treatment modality associated with lower annual hospital costs over time. Our study shows that VNS is a cost-beneficial treatment for a national cohort of pediatric patients with refractory epilepsy.

SUBMITTER: Zhang L

PROVIDER: S-EPMC9311159 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectivesThis study was undertaken to estimate the cost-effectiveness of deep brain stimulation (DBS) compared with vagus nerve stimulation (VNS) and care as usual (CAU) for adult patients with refractory epilepsy from a health care perspective using a lifetime decision analytic model.MethodsA Markov decision analytic model was constructed to estimate the lifetime cost-effectiveness of DBS compared with VNS and CAU. Transition probabilities were estimated from a randomized controlled trial, and assumptions were made in consensus with an expert panel. Primary outcomes were expressed as incremental costs per quality-adjusted life-year (QALY) and per responder. Univariate and probabilistic sensitivity analyses were conducted to characterize parameter uncertainty.ResultsIn DBS, 28.4% of the patients were responders, with an average of 21.38 QALYs per patient and expected lifetime health care costs of €187 791. VNS had fewer responders (22.3%), fewer QALYs (20.70), and lower lifetime costs (€156 871). CAU had the fewest responders (6.2%), fewest QALYs (18.74), and lowest total health care costs (€64 670). When comparing with CAU, incremental cost-effectiveness ratios (ICERs) showed that costs per QALY gained were slightly lower for DBS (€46 640) than for VNS (€47 155). When comparing DBS with VNS, an incremental cost per additional QALY gained of €45 170 was found for DBS. Sensitivity analyses showed that ICERs were heavily dependent on assumptions regarding loss to follow-up in the respective clinical trial.SignificanceThis study suggests that, given current limited evidence, VNS and DBS are potentially cost-effective treatment strategies compared to CAU for patients with refractory epilepsy. However, results for DBS were heavily impacted by assumptions made to extrapolate nonresponse from the original trial. More stringent assumptions regarding nonresponse resulted in an ICER just above an acceptable willingness to pay threshold. Given the uncertainty surrounding the effectiveness of DBS and the large impact of assumptions related to nonresponse, further empirical research is needed to reduce uncertainty.