Health Care System Costs Associated With Surgery and Medical Therapy for Children With Drug-Resistant Epilepsy in Ontario

Abstract

Background and ObjectivesImprovement in seizure control after epilepsy surgery could lead to lower health care resource use and costs, but it is uncertain whether this could offset the high costs related to surgery. This study aimed to evaluate phase-specific and cumulative long-term health care costs of surgery compared to medical therapy in children with drug-resistant epilepsy from the health care payer perspective.MethodsChildren who were evaluated for epilepsy surgery and treated with surgery or medical therapy from 2003 to 2018 at the Hospital for Sick Children in Toronto were identified from chart review and linked to their health administrative databases in Ontario, Canada. Inverse probability of treatment weighting with stabilized weights was used to balance the baseline covariates between the 2 groups. Patients were assigned to presurgery, surgery, short-term (first 2 years), intermediate-term (2–5 years), and long-term (>5 years) postsurgery care phases on the basis of treatment trajectory. Phase-specific and cumulative long-term health care costs were evaluated. Costs were converted from Canadian to US dollars year 2018 value.ResultsThere were 372 surgical and 258 medical patients. Costs were higher in surgical than medical patients for presurgery (3 and 39 weeks), surgery, and short-term care phase, and the attributable costs of surgery per 7 patient-days were $1,602 (95% CI $1,438–$1,785), $172 (95% CI $147–$185), $19,819 (95% CI $18,822–$20,932), and $28 (95% CI $22–$32), respectively. Costs were lower in surgical patients for intermediate- and long-term care phase, and the attributable costs were −$72 (95% CI −$124 to −$35) and −$94 (95% CI −$129 to −$63), respectively. In surgical patients, costs were highest for surgery followed by presurgery care phase, with hospitalizations accounting for the highest cost component. In medical patients, costs increased gradually from presurgery to long-term care phase. Cumulative costs were higher for surgical than medical patients in the first 7 years after surgery, but from 8 years on, costs were lower for surgical patients.DiscussionThis study demonstrated the long-term economic benefits of epilepsy surgery compared to medical therapy for the health care system with the use of real-world data, which would justify the high costs of surgery. The results will support future economic evaluation comparing minimally invasive treatment such as laser therapy to surgery.

Trajectory of Health-Related Quality of Life After Pediatric Epilepsy Surgery

“…Understanding the evolution of HRQOL after surgery compared with medical therapy is important in counseling children and parents and will contribute to informed decision-making on treatment options. By demonstrating that epilepsy surgery leads to improvement in seizure freedom and HRQOL in children, which has downstream effects such as better educational and vocational attainment and reduced health care resource utilization and health care cost, our study provided objective evidence to justify the high costs of surgery and to improve access to surgery.…”

The State of Specialized Epilepsy Care in the States: Increased Access, New Tools, but the Same Dismal Underutilization of Epilepsy Surgery

“…Increasing the utilization of epilepsy surgery has clear financial incentives at a population level because DRE patients account for a large proportion of direct epilepsy healthcare costs, and epilepsy surgery is cost-effective compared to medical management across different healthcare systems. 6 , 12 , 13 In the absence of national stewardship for epilepsy surgery, the findings of Ostendorf et al should be a call to action for us, the epilepsy care providers. The ongoing underutilization of resective epilepsy surgery underscores the need to understand and resolve barriers to adoption of this potentially curative intervention.…”

Costs for Children With Drug-Resistant Epilepsy

“…The authors state that cost-effectiveness from epilepsy surgery may need to be evaluated beyond 3 years, 6 as was done in the study by Widjaja and colleagues. 2 A 2019 study in Australia used a similar ICER methodology and noted a higher expense for epilepsy surgery patients after 7.6 years. 7 A study using a database from various children's hospitals noted a decrease in health care use in children after epilepsy surgery compared to patients on medication therapy using propensity scoring.…”

“…In this issue of Neurology ®, Widjaja and colleagues 2 report findings from an analysis of data from the Hospital for Sick Children in Toronto. The authors compared health care costs in children with drug resistant epilepsy (DRE) receiving surgical and those receiving medical therapies beyond a 3-year endpoint.…”