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An analysis of real-world data shows that the long-term economic benefits of surgery for drug-resistant epilepsy outweigh the initial costs of the surgery when compared with medical therapy.


“Epilepsy surgery has been shown to be effective in improving seizure control in children with drug-resistant epilepsy, and the American Academy of Neurology recommends surgery for the treatment of focal drug-resistant epilepsy,” explains Elysa Widjaja, MD, PhD, MPH, MBBS, MRCP, FRCR. “It is expected that improvement in seizures following surgery would result in a decrease in healthcare resource use and healthcare costs. However, it is unclear whether the decrease in costs from reduced healthcare resource use could counteract the high costs related to the surgical procedure and hospitalization.”

For a study published in Neurology, Dr. Widjaja and colleagues sought to assess phase-specific and cumulative long-term healthcare costs associated with surgery compared with medical therapy among children with drug-resistant epilepsy. Investigators categorized patients into the following phases: pre-surgery, surgery, short-term (first 2 years), intermediate term (2-5 years), and long-term (>5 years). They analyzed phase-specific and cumulative long-term healthcare costs, with conversion from Canadian to US dollars.

Cumulative Costs of Surgery Lower Than Medical Therapy

The study included 372 patients who underwent surgery (mean age, 9.7; 56.7% male) and 258 patients treated with medical therapy (mean age, 10.9; 51.9% male). More patients in the surgical group than in the medical therapy group experienced daily seizures (52.4% vs 45.0%).

“We showed that healthcare costs were greater in patients who underwent surgery compared with patients receiving medical therapy for pre-surgery care, surgery care, and the short-term post-surgery care phase,” says Dr. Widjaja. “However, costs in the intermediate-term and long-term post-surgery care phases were lower among patients who underwent surgery than patients treated with medical therapy. Among patients who underwent surgery, costs were highest in the surgery care phase.”

Specifically, the associated costs of surgery per 7 patient-days were $1,602 and $172 for pre-surgery (3 and 39 weeks, respectively); $19,819 for surgery; and $28 for the short-term care phase. Attributable costs were lower for patients who underwent surgery in the intermediate and long-term phases of care, at −$72 and −$94, respectively.

Investigators also found that the cumulative healthcare costs of surgical treatment were higher than medical therapy in the first 7 years following surgery (Figure). “However, the cumulative costs of medical therapy rose at a greater rate, such that from 8-10 years after surgery, the cumulative costs of surgical treatment were lower than medical therapy,” Dr. Widjaja notes.

Long-Term Economic Benefits Justify Initial Costs

While the current study examined healthcare costs in a single pediatric epilepsy center, Dr. Widjaja believes that the findings “are generalizable to other centers in Canada, the US, and other countries, in that the initial high costs of epilepsy surgery would be countered by the lesser costs of intermediate- and long-term care phases, such that the cumulative long-term costs of surgery would be lower compared with those of medical therapy.”

However, she noted that the scale of the costs of surgery and medical patients would vary from that of other countries because of differences in healthcare systems.

“The results of this study provide persuasive evidence for the long-term economic benefits of surgery compared with medical therapy for the healthcare system using real-world data, and therefore justification for the initial high costs of surgery to stakeholders,” Dr. Widjaja says.

She also pointed to directions for future research based on this work.

“The costs data generated from this study will provide essential data for future economic evaluation comparing minimally invasive treatment, such as MR-guided laser interstitial thermal therapy, to epilepsy surgery,” Dr. Widjaja notes.

 

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