Cost-effectiveness analysis of epilepsy surgery in children and adolescents with drug resistant focal epilepsy at three years in a tertiary care epilepsy center in Thailand

Anurat, Kingthong; Khongkhatithum, Chaiyos; Pattanaprateep, Oraluck; Chamroonrat, Wichana; Boongird, Atthaporn; Visudtibhan, Anannit; Thampratankul, Lunliya

doi:10.1016/j.jocn.2020.07.051

Cited by 5 publications

(20 citation statements)

References 24 publications

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“…The included studies contain data from seven different countries (Table 2). Five studies [25–29] were from the USA, three from Canada [30–32], two from Thailand [33, 34] and one each from Belgium [35], Australia [36], Hungary [37] and France [38]. The most recent study was published in 2021 [37] and the earliest in 1995 [32].…”

Section: Resultsmentioning

confidence: 99%

“…One study [32] did not provide any details on the hypothetical cohort the model was based on. In total, five studies solely focused on children or adolescents [25,28,31,33,36]. The proportion of female patients ranged between 50% and 61% in four studies [28,33,34,38].…”

Section: Ta B L Ementioning

confidence: 99%

“…Analyses were performed from the healthcare perspective in nine studies [25,27,28,[30][31][32][35][36][37] and from the societal perspective in four studies [26,29,34,38]. One study [33] did not report the perspective. Included cost components varied between the studies (Table 3).…”

Section: Costsmentioning

confidence: 99%

“…Other direct medical costs, which were not considered by all studies, were those for presurgical evaluation [28,31,33,35,36], emergency department visits [28,29,[31][32][33]38] and rehabilitation services [28,36]. In addition to direct medical costs, four studies [32,33,36,38] also included direct non-medical costs.…”

Section: Costsmentioning

confidence: 99%

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Cost‐effectiveness of surgical treatment compared to medical treatment in patients with drug‐refractory epilepsy: A systematic review

Kitschen

Aleknonytė‐Resch

Sakalytė

et al. 2022

Euro J of Neurology

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Background and purpose Approximately 30% of epilepsy patients develop a drug‐refractory epilepsy, that is, seizures cannot be controlled with antiepileptic drugs. Surgery has been evaluated as an effective but costly form of treatment. The aim of this systematic review is to synthesize the available evidence on the cost‐effectiveness of surgical treatment compared to medical treatment for these patients. Method A systematic literature search was performed in MEDLINE, Embase, PsycINFO, Cochrane Library and the National Health Service Economic Evaluation Database until September 2022. Title, abstract and full‐text screening were conducted by two researchers. Original studies published in English or German analyzing the cost‐effectiveness of surgical compared to medical treatment were included. Study characteristics, effectiveness measures, costs and incremental cost‐effectiveness ratios (ICERs) were extracted. The quality of studies was assessed using the Drummond checklist. Results Fourteen studies were included. Most studies evaluated surgery as cost‐effective. The ICER per patient seizure free ranged from dominant to purchasing power parity US dollars (PPP‐USD) 479,275. The ICER per 1% seizure reduction ranged from PPP‐USD 227 to PPP‐USD 342. The ICER per year without seizures was PPP‐USD 4202 and the ICER per quality‐adjusted life‐year ranged from dominant to PPP‐USD 90,874. The studies varied greatly in their methodology and time horizon. Conclusion Surgical treatment is cost‐effective compared to medical treatment, especially when a lifetime horizon is adopted. It is concluded that all disease‐specific costs should be considered over a long period when assessing the cost‐effectiveness of epilepsy treatment. From an economic perspective, efforts should be made to improve access to surgical treatment for patients with drug‐refractory epilepsy.

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Section: Resultsmentioning

confidence: 99%

Section: Ta B L Ementioning

confidence: 99%

Section: Costsmentioning

confidence: 99%

Section: Costsmentioning

confidence: 99%

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Cost‐effectiveness of surgical treatment compared to medical treatment in patients with drug‐refractory epilepsy: A systematic review

Kitschen

Aleknonytė‐Resch

Sakalytė

et al. 2022

Euro J of Neurology

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“…However, the balance between the high initial cost of presurgical evaluation and surgical intervention and future economic benefits is difficult to estimate a priori in individual cases. It is not a short-term effect and strongly depends on the specific situation, outcome, and improvement in QoL [147,149,157]. Economic constraints can be an obstacle to epilepsy surgery, but the individual decision to undergo surgery, if financially feasible, is not primarily determined by the economic perspective but by the desire to overcome the disease burden [140].…”

Section: Healthcare System and Economic Constraintsmentioning

confidence: 99%

Outlines to Initiate Epilepsy Surgery in Low- and Middle-Income Countries

Bäuerle¹,

Schneider²,

Holtkamp³

et al. 2022

J. Integr. Neurosci.

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Surgery is an essential treatment option for patients with drug-resistant epilepsy. While most epilepsy patients worldwide live in low-and middle-income countries (LMIC), most of these countries do not have epilepsy surgery, and those that do have surgical epilepsy services lack capacities. The rapidly growing population in LMIC further widens the gap between the number of patients who can potentially benefit from surgery and those who can actually receive it. This makes the initiation of new surgical epilepsy centers in those countries an urgent issue. Epilepsy surgery is feasible in LMIC, even in resource-poor settings, but lack of local expertise is a major obstacle to the introduction of new surgical services. Importantly, expertise deficits can be compensated by collaborating with a well-established epilepsy center for knowledge transfer, skill building and mentoring. Such projects need to be organized in a multidisciplinary team, should focus on the given circumstances, and should use technologies and personnel that are reasonably available and can function sustainably. Local cultural factors and improvement of patients' quality of life are further spotlights reflected by an increasing number of studies. As a general outline for a new surgical epilepsy program in LMIC, it is recommended to initially focus on patients with mesial temporal lobe epilepsy due to hippocampal sclerosis or other well defined pathologies. These constellations have an excellent surgical outcome in terms of seizure control, can be diagnosed by non-invasive methods, and can be reliably identified even under low-resource conditions. Moreover, surgery can be performed with a highly standardized approach and at reasonable costs, and the vast majority of patients will benefit from surgical intervention. The range of services can then be gradually expanded, depending on growing expertise, local needs, prospects and constraints. Although the introduction of surgical epilepsy services in LMIC can face several challenges, none of them should be a permanent barrier for further establishments.

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Understanding cost effectiveness in neurology

Sánchez Fernández

2023

Journal of the Neurological Sciences

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Cost-effectiveness analysis of epilepsy surgery in children and adolescents with drug resistant focal epilepsy at three years in a tertiary care epilepsy center in Thailand

Cited by 5 publications

References 24 publications

Cost‐effectiveness of surgical treatment compared to medical treatment in patients with drug‐refractory epilepsy: A systematic review

Cost‐effectiveness of surgical treatment compared to medical treatment in patients with drug‐refractory epilepsy: A systematic review

Outlines to Initiate Epilepsy Surgery in Low- and Middle-Income Countries

Understanding cost effectiveness in neurology

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