Comparisons of direct and indirect utilities in adult epilepsy populations: A systematic review

Foster, Emma; Chen, Zhibin; Ofori‐Asenso, Richard; Norman, Richard; Carney, Patrick; O’Brien, Terence J.; Kwan, Patrick; Liew, Danny; Ademi, Zanfina

doi:10.1111/epi.16396

Cited by 9 publications

(12 citation statements)

References 26 publications

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“…The convergence of results from these three methods adds confidence to our interpretation. Future studies may benefit from measures of utility in the RNS population, although this may present its own challenges, as standard utility questionnaire scores do not always capture long‐term benefit in epilepsy well 39 …”

Section: Discussionmentioning

confidence: 99%

“…Future studies may benefit from measures of utility in the RNS population, although this may present its own challenges, as standard utility questionnaire scores do not always capture long-term benefit in epilepsy well. 39 Second, we calculated epilepsy-related costs based on health utilization incidences in a past work on pharmacotherapy, which is also indirect. 29 However, given that Tremblay et al 29 was a recently published article utilizing data from the United States health care system, and the incidences reported are similar to those in other published work, 40 the rates appear applicable to our analysis.…”

Section: Limitationsmentioning

confidence: 99%

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Cost‐effectiveness analysis of responsive neurostimulation for drug‐resistant focal onset epilepsy

et al. 2021

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Objective We evaluated the incremental cost‐effectiveness of responsive neurostimulation (RNS) therapy for management of medically refractory focal onset seizures compared to pharmacotherapy alone. Methods We created and analyzed a decision model for treatment with RNS therapy versus pharmacotherapy using a semi‐Markov process. We adopted a public payer perspective and used the maximum duration of 9 years in the RNS long‐term follow‐up study as the time horizon. We used seizure frequency data to model changes in quality of life and estimated the impact of RNS therapy on the annual direct costs of epilepsy care. The model also included expected mortality, adverse events, and costs related to system implantation, programming, and replacement. We interpreted our results against societal willingness‐to‐pay thresholds of $50 000, $100 000, and $200 000 per quality‐adjusted life year (QALY). Results Based on three different calculated utility value estimates, the incremental cost‐effectiveness ratio (ICER) for RNS therapy (with continued pharmacotherapy) compared to pharmacotherapy alone ranged between $28 825 and $46 596. Multiple sensitivity analyses yielded ICERs often below $50 000 per QALY and consistently below $100 000/QALY. Significance Modeling based on 9 years of available data demonstrates that RNS therapy for medically refractory epilepsy very likely falls within the range of cost‐effectiveness, depending on method of utility estimation, variability in model inputs, and willingness‐to‐pay threshold. Several factors favor improved cost‐effectiveness in the future. Given the increasing focus on delivering cost‐effective care, we hope that this analysis will help inform clinical decision‐making for this surgical option for refractory epilepsy.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Cost‐effectiveness analysis of responsive neurostimulation for drug‐resistant focal onset epilepsy

et al. 2021

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“…Furthermore, the terminology used to describe the QA process varied considerably among the SLRs. Terms such as quality appraisal or assessment [ 9 , 23 , 24 , 48 , 49 , 51 , 53 , 55 , 57 – 60 , 73 – 78 ], critical appraisal [ 47 ], risk of bias assessment [ 25 , 62 , 63 , 72 , 79 – 82 ], relevancy and quality assessment [ 52 , 56 ], assessment of quality and data appropriateness [ 50 ], methodological quality assessment [ 26 , 27 , 46 , 54 , 61 , 69 ], reporting quality [ 71 , 83 ] credibility checks and methodological review [ 70 ] were used loosely and interchangeably. One study [ 84 ] mentioned three terms, RoB, methodological quality and reporting quality, in their description of the QA process.…”

Section: Resultsmentioning

confidence: 99%

Quality appraisal for systematic literature reviews of health state utility values: a descriptive analysis

Muchadeyi

Hernandez-Villafuerte

Schlander

2022

BMC Med Res Methodol

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Background Health state utility values (HSUVs) are an essential input parameter to cost-utility analysis (CUA). Systematic literature reviews (SLRs) provide summarized information for selecting utility values from an increasing number of primary studies eliciting HSUVs. Quality appraisal (QA) of such SLRs is an important process towards the credibility of HSUVs estimates; yet, authors often overlook this crucial process. A scientifically developed and widely accepted QA tool for this purpose is lacking and warranted. Objectives To comprehensively describe the nature of QA in published SRLs of studies eliciting HSUVs and generate a list of commonly used items. Methods A comprehensive literature search was conducted in PubMed and Embase from 01.01.2015 to 15.05.2021. SLRs of empirical studies eliciting HSUVs that were published in English were included. We extracted descriptive data, which included QA tools checklists or good practice recommendations used or cited, items used, and the methods of incorporating QA results into study findings. Descriptive statistics (frequencies of use and occurrences of items, acceptance and counterfactual acceptance rates) were computed and a comprehensive list of QA items was generated. Results A total of 73 SLRs were included, comprising 93 items and 35 QA tools and good recommendation practices. The prevalence of QA was 55% (40/73). Recommendations by NICE and ISPOR guidelines appeared in 42% (16/40) of the SLRs that appraised quality. The most commonly used QA items in SLRs were response rates (27/40), statistical analysis (22/40), sample size (21/40) and loss of follow up (21/40). Yet, the most commonly featured items in QA tools and GPRs were statistical analysis (23/35), confounding or baseline equivalency (20/35), and blinding (14/35). Only 5% of the SLRS used QA to inform the data analysis, with acceptance rates of 100% (in two studies) 67%, 53% and 33%. The mean counterfactual acceptance rate was 55% (median 53% and IQR 56%). Conclusions There is a considerably low prevalence of QA in the SLRs of HSUVs. Also, there is a wide variation in the QA dimensions and items included in both SLRs and extracted tools. This underscores the need for a scientifically developed QA tool for multi-variable primary studies of HSUVs.

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“…Ortega 2020, Mexico 14 20 68 (76) 56 (63) 12 11 12 11 24 59 (58) 28 28 31 30 43 42 5 238 (65) 192 (52) 46 13 81 22 14 (Continues) Figure 3B). There was a statistically significant reduction in post-surgery total unemployment when results were stratified into high-income countries (RR = 0.74; 95% CI: 0.57-0.96, p = .026), but not in middle-income countries, although a trend for improvement was evident (RR = 0.65; 95% CI: 0.42-1.02, p = .063).…”

Section: Major Findingsmentioning

confidence: 99%

“…12,13 In addition to increased mortality, DRE negatively affects the quality of life of patients in several critical domains, including psychosocial well-being, loss of educational and employment attainment, and cognitive dysfunction. 12,14 DRE may also have significant implications from a health economic perspective, as measured in terms of direct and indirect costs. 15 Direct costs refer to health care utilization, such as hospital admissions, outpatient appointments, and medication costs.…”

Section: Introductionmentioning

confidence: 99%

The effect of epilepsy surgery on productivity: A systematic review and meta‐analysis

et al. 2022

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Objectives An important but understudied benefit of resective epilepsy surgery is improvement in productivity; that is, people's ability to contribute to society through participation in the workforce and in unpaid roles such as carer duties. Here, we aimed to evaluate productivity in adults with drug‐resistant epilepsy (DRE) pre‐ and post‐resective epilepsy surgery, and to explore the factors that positively influence productivity outcomes. Methods We conducted a systematic review and meta‐analysis using four electronic databases: Medline (Ovid), EMBASE (Ovid), EBM Reviews ‐ Cochrane Central Register of Controlled Trials (CENTRAL), and Cochrane Library. All studies over the past 30 years reporting on pre‐ and post‐resective epilepsy surgical outcomes in adults with DRE were eligible for inclusion. Meta‐analysis was performed to assess the post‐surgery change in employment outcomes. Results A total of 1005 titles and abstracts were reviewed. Seventeen studies, comprising 2056 unique patients, were suitable for the final quantitative synthesis and meta‐analysis. Resective epilepsy surgery resulted in a 22% improvement in overall productivity (95% confidence interval [CI]: 1.07–1.40). The factors associated with increased post‐surgery employment risk ratios were lower pre‐surgical employment in the workforce (relative risk ratio [RRR] =0.34; 95% CI: 0.15–0.74), shorter follow‐up duration (RRR = 0.95; 95% CI: 0.90–0.99), and lower mean age at time of surgery (RRR= 0.97; 95% CI: 0.94–0.99). The risk of bias of the included studies was assessed using Risk Of Bias In Non‐randomised Studies ‐ of Interventions and was low for most variables except ”measurement of exposure.” Significance There is clear evidence that resective surgery in eligible surgical DRE patients results in improved productivity. Future work may include implementing a standardized method for collecting and reporting productivity in epilepsy cohorts and focusing on ways to reprioritize health care resource allocation to allow suitable candidates to access surgery earlier. This will ultimately benefit individuals with DRE, their families, our communities, and the wider health care system.

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Comparisons of direct and indirect utilities in adult epilepsy populations: A systematic review

Cited by 9 publications

References 26 publications

Cost‐effectiveness analysis of responsive neurostimulation for drug‐resistant focal onset epilepsy

Cost‐effectiveness analysis of responsive neurostimulation for drug‐resistant focal onset epilepsy

Quality appraisal for systematic literature reviews of health state utility values: a descriptive analysis

The effect of epilepsy surgery on productivity: A systematic review and meta‐analysis

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