Cost-effectiveness analysis of invasive EEG monitoring in drug-resistant epilepsy

Abstract

Our aim was to determine the cost-effectiveness of two intracranial electroencephalography (iEEG) interventions: 1) stereoelectroencephalography (SEEG) and 2) placement of subdural grid electrodes (SDGs) both followed by resective surgery in patients with drug-resistant, partial-onset epilepsy, compared with medical management (MM) in Hungary from payer's perspective. Methods: The incremental health gains and costs of iEEG interventions have been determined with a combination of a decision tree and prevalence Markov process model over a 30-year time horizon in a cost-utility analysis (CUA). To address the effect of parameter uncertainty on the incremental costeffectiveness ratio (ICER), deterministic and probabilistic sensitivity analyses were performed. Results: Our results showed that both SEEG and SDG interventions represent a more expensive but more effective strategy than MM representing the current standard of care. The total discounted cost of SEEG and SDG were € 32,760 and € 25,028 representing € 18,108 and € 10,375 additional cost compared with MM, respectively. However, they provide an additional 3.931 (in SEEG group) and 3.444 quality-adjusted life years (QALYs; in SDG group), correspondingly. Thus, the ICER of SEEG is € 4607 per QALY gain, while the ICER for SDG is € 3013 per QALY gain, compared with MM. At a cost-effectiveness threshold of € 41,058 per QALY in Hungary, both subtypes of iEEG interventions are cost-effective and provide good value for money. Significance: Because of the high cost of implanting electrodes and monitoring, the invasive EEG for patients with refractory epilepsy is currently not available in the Hungarian national healthcare system. Our study demonstrated that these procedures in Hungary are cost-effective compared with the MM. As a result, the introduction of iEEG interventions to the reimbursement list of the National Health Insurance Fund Administration was initiated.

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

“…The proportion of female patients ranged between 50% and 61% in four studies [28, 33, 34, 38]. The remaining studies did not report the share of female patients [25–27, 29–32, 35–37].…”

“…Two economic evaluations were based on a single observational study [28,35], six on decision-analytic modeling using data from a single observational study [26,31,33,34,36,38] and six on decisionanalytic modeling using hypothetical cohorts [25,27,29,30,32,37].…”

Trends in resource utilization and cost of illness in patients with active epilepsy in Germany from 2003 to 2020

“…However, these therapies and procedures have been shown to have an overall cost advantage and to be cost-effective from a health economic point of view. [56][57][58] The significant reduction in outpatient diagnostic costs in 2020 compared with 2013 could alternatively be explained by the SARS-CoV-2 pandemic, which significantly reduced the availability and utilization of specialized outpatient care. 59 In 2020, the SARS-CoV-2 pandemic hit health and economic systems around the world hard, and it seems possible that the pandemic could have had an influence on our study.…”

“…Therefore, costs for these therapies and procedures are not captured in our study. However, these therapies and procedures have been shown to have an overall cost advantage and to be cost‐effective from a health economic point of view 56–58 . The significant reduction in outpatient diagnostic costs in 2020 compared with 2013 could alternatively be explained by the SARS‐CoV‐2 pandemic, which significantly reduced the availability and utilization of specialized outpatient care 59 …”

Dollars and Sense: Cost-Effectiveness of Epilepsy Surgery

“…While adding the burden and cost of invasive monitoring could render these conclusions overly optimistic, at least other research allays this concern by supporting the cost-effectiveness of intracranial EEG itself. 4 Also unstudied were children, extratemporal epilepsy (where cost-effectiveness might be worse due to lower effectiveness), a comparison of surgery to responsive neuromodulation or deep brain stimulation. Data also relied on ER/hospitalization rates/costs within Cleveland Clinic which might not generalize to other less resource-rich centers.…”