One‐year cost‐effectiveness of callosotomy vs vagus nerve stimulation for drug‐resistant seizures in Lennox‐Gastaut Syndrome: A decision analytic model

Abel, Taylor J.; Remick, Madison; Welch, William C.; Smith, Kenneth J.

doi:10.1002/epi4.12570

Cited by 14 publications

(21 citation statements)

References 22 publications

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“…Interestingly, while other device companies have invested in transcutaneously rechargeable pulse generators, this is not yet available for children with VNS. Investing in this technology would make VNS not only more cost-effective, 33 but also safer, as our results demonstrate.…”

Section: Discussionsupporting

confidence: 60%

Predictors of vagus nerve stimulation complications among pediatric patients with drug-resistant epilepsy

Muthiah

Sharma

Vodovotz

et al. 2022

Journal of Neurosurgery: Pediatrics

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OBJECTIVE Complications from vagus nerve stimulator (VNS) procedures are common and can have important implications for morbidity and seizure control, yet predictors of complications are poorly understood. The objective of this study was to assess clinical factors associated with minor and major complications from VNS procedures among pediatric patients with drug-resistant epilepsy. METHODS The authors performed an 11-year retrospective review of patients who underwent VNS procedures for drug-resistant epilepsy at age < 21 years. The primary outcome was complications (minor or major) following VNS surgery. Preoperative and surgery characteristics were compared between patients who developed versus those who did not develop complications. Multivariable Poisson regression was performed to determine the association between preoperative characteristics and infection. RESULTS Of 686 surgeries, 48 complications (7.0%) developed; there were 7 minor complications (1.0%) and 41 major complications (6.0%). Surgeries with minor complications were an average of 68 minutes longer than those without minor complications (p < 0.001). The incidence rate of infection was 1 per 100 person-years, with 3% of procedures complicated by infection. Poisson regression revealed that after adjusting for age at surgery, duration of surgery, and primarily motor seizure semiology, the incident rate of infection for revision surgeries preceded by ≥ 2 procedures was 19 times that of first-time revisions. CONCLUSIONS The overall minor complication rate was 1% and the overall major complication rate was 6% for VNS procedures. Longer surgery duration was associated with the development of minor complications but not major complications. Repeat incisions to the VNS pocket may be associated with higher incident rate of infection, highlighting a need for longer-lasting VNS pulse generator models.

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Section: Discussionsupporting

confidence: 60%

Predictors of vagus nerve stimulation complications among pediatric patients with drug-resistant epilepsy

Muthiah

Sharma

Vodovotz

et al. 2022

Journal of Neurosurgery: Pediatrics

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“…However, other studies have found similar effectiveness for both treatments 5,9,10 . Additionally, VNS seems more cost‐effective 1 year after surgery and is associated with fewer complications 4,10,11 . However, this study did not evaluate long‐term cost‐effectiveness (considering the need for VNS battery replacement), which may prove CC is more cost‐effective.…”

Section: Discussionmentioning

confidence: 80%

Added value of corpus callosotomy following vagus nerve stimulation in children with Lennox–Gastaut syndrome: A multicenter, multinational study

Roth,

Bergman,

Weil

et al. 2023

Epilepsia

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ObjectiveLennox‐Gastaut syndrome (LGS) is a severe form of epileptic encephalopathy, presenting during the first years of life, and is very resistant to treatment. Once medical therapy has failed, palliative surgeries such as vagus nerve stimulation (VNS) or corpus callosotomy (CC) are considered. While CC is more effective than VNS as the primary neurosurgical treatment for LGS associated drop attacks, there is limited data regarding the added value of CC following VNS. This study aimed to assess the effectiveness of CC preceded by VNS.MethodsThis multinational, multicenter retrospective study focuses on LGS children that underwent CC before the age of 18 years, following prior VNS, which failed to achieve satisfactory seizure control. Collected data included epilepsy characteristics, surgical details, epilepsy outcomes, and complications. The primary outcome of this study was a reduction of 50% drop attacks.Results127 cases were reviewed (80 males). The median age at epilepsy onset was 6 months, IQR (3.12, 22.75). The median age at VNS surgery was 7 years, IQR (4, 10), and CC was performed at a median age of 11 years, IQR (8.76, 15). The dominant seizure type was drop attacks (tonic or atonic) in 102 patients. 86 patients underwent a single‐stage complete CC, and 41 an anterior callosotomy. Ten patients who did not initially have a complete CC underwent a second surgery for completion of CC due to seizure persistence. Overall, there was at least a 50% reduction in drop attacks and other seizures, in 83% and 60% respectively. Permanent morbidity occurred in 1.5%, with no mortality.SignificanceCC is vital in seizure control in children with LGS who failed VNS. Surgical risks are low. A complete CC has a tendency towards better effectiveness than anterior CC for some seizure types.

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“…The number of trial‐based and model‐based economic evaluations was n = 7 (39%) and n = 11 (61%), respectively. More specifically, different types of model‐based economic evaluations were performed: decision tree modeling ( n = 4, 22%) 22,23,33,37 and Markov modeling ( n = 7, 39%) 20,21,24,26,30,32,36 . Two model‐based studies compared two nonpharmacological interventions (i.e., one compared KD and VNS and another compared DBS and VNS) with CAU 21,24 .…”

Section: Resultsmentioning

confidence: 99%

“…Six of those compared epilepsy surgery with CAU (i.e., ASM treatment), of which two were focused on children, one on both adults and children, and three on adults solely. One study assessed the cost‐effectiveness of epilepsy surgery via corpus callosotomy in children by comparing it to VNS using a decision‐analytic model 21 . One study assessed the cost‐effectiveness of a new minimally invasive epilepsy surgery technique, MRgLITT, with the conventional epilepsy surgery in adults.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, two studies (Catchpool et al 23 and Anurat et al 22 ) found that epilepsy surgery was not cost‐effective in children with drug‐resistant epilepsy when compared with CAU (i.e., ASM treatment). However, the study of Anurat et al used a short time horizon and emphasized that epilepsy surgery may be cost‐effective if evaluated beyond 3 years, and Catchpool et al used a health care perspective, stating that “including benefits outside of a health care perspective would likely lead to a more compelling cost‐effective argument.” Abel et al 21 showed that, at 1‐year follow‐up, epilepsy surgery via the corpus callosum is cost‐effective when compared with VNS, with an ICER of $567 770 per positive seizure gained (i.e., seizure freedom or >50% seizure reduction).…”

Section: Resultsmentioning

confidence: 99%

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Economic evaluations of nonpharmacological treatments for drug‐resistant epilepsy: A systematic review

Chan,

Janssen,

Wijnen

et al. 2023

Epilepsia

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ObjectiveTo systematically identify and critically appraise all published full economic evaluations assessing the cost‐effectiveness of non‐pharmacological interventions for patient with drug‐resistant epilepsy.MethodsPICOS was used to design search strategies for the identification and selection of relevant studies. Literature search was performed using MEDLINE (via PubMed), EMBASE, INAHTA, EHS EED, and CEA Registry databases to identify articles published between January 2000 to May 2023. Web of Science was additionally used to perform forward and backward referencing. Title‐, abstract‐ and full‐text screening was performed by two independent researchers. The Consensus Health Economic Criteria (CHEC) checklist and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 were applied for quality assessment.ResultsA total of 4,470 studies were identified of which 18 met our inclusion criteria. Twelve of the studies conducted model‐based economic evaluation and others were trial‐based. Three studies showed that epilepsy surgery was cost‐effective in adults, while this remained inconclusive for children (two positive, three negative). Three studies showed negative economic outcome for ketogenic diet in children. One out of four studies showed positive results for self‐management. For vagus nerve stimulation, one study showed positive results in adults and another one negative result in children. One recent study showed cost‐effectiveness of RNS in adults. Finally, one study shows promising but inconclusive results for deep brain stimulation. Mean risk of bias assessment score (based on CHEC) was 95.3% and 80.9% for reporting quality (CHEERS 2022).SignificanceThis review identified studies that assessed the cost‐effectiveness of non‐pharmacological treatments in both adults and children with drug‐resistant epilepsy, suggesting that in adults, epilepsy surgery, VNS and RNS are cost‐effective, and that DBS and self‐management appear to be promising. In children, epilepsy surgery seems to be cost‐effective. Contrary, the use of ketogenic diet was shown not to be cost‐effective. However, limited long‐term data was available for newer interventions (i.e., ketogenic diet, DBS, and RNS).

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One‐year cost‐effectiveness of callosotomy vs vagus nerve stimulation for drug‐resistant seizures in Lennox‐Gastaut Syndrome: A decision analytic model

Cited by 14 publications

References 22 publications

Predictors of vagus nerve stimulation complications among pediatric patients with drug-resistant epilepsy

Predictors of vagus nerve stimulation complications among pediatric patients with drug-resistant epilepsy

Added value of corpus callosotomy following vagus nerve stimulation in children with Lennox–Gastaut syndrome: A multicenter, multinational study

Economic evaluations of nonpharmacological treatments for drug‐resistant epilepsy: A systematic review

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