Medical therapy

Economic advantages of surgery compared to medical therapy in drug-resistant epilepsy

An analysis of real-world data shows that the long-term economic benefits of surgery for drug-resistant epilepsy outweigh the upfront costs of surgery compared to medical treatment.

“Epilepsy surgery has been shown to improve seizure control in children with drug-resistant epilepsy, and the American Academy of Neurology recommends surgery for the treatment of drug-resistant focal epilepsy “, explains Elysa Widjaja, MD, PhD, MPH, MBBS, MRCP, FRCR. “Improvement in seizures after surgery is expected to lead to decreased use of healthcare resources and healthcare costs. However, it is unclear whether the decreased costs due to reduced use of healthcare resources could outweigh the high costs associated with surgery and hospitalization.

For a study published in Neurology, Dr. Widjaja and colleagues sought to assess the phase-specific and cumulative long-term healthcare costs associated with surgery versus medical treatment in children with drug-resistant epilepsy. Investigators categorized patients into the following phases: preoperative, surgical, short-term (first 2 years), mid-term (2-5 years), and long-term (>5 years). They analyzed phase-specific and cumulative long-term health care costs, with conversion from Canadian dollars to US dollars.

Lower cumulative costs of surgery than medical therapy

The study included 372 patients who underwent surgery (mean age, 9.7; 56.7% male) and 258 patients treated with medical treatment (mean age, 10.9; 51.9% male). men). More patients in the surgical group than in the medical treatment group experienced daily seizures (52.4% versus 45.0%).

“We showed that healthcare costs were higher in patients who underwent surgery than in patients receiving medical treatment for preoperative care, surgical care, and the short-term postoperative care phase,” says Dr Wijaja. “However, the costs of the mid- and long-term postoperative care phases were lower in patients who underwent surgery than in patients treated with medical therapy. Among patients who underwent surgery, costs were highest in the surgical care phase.

Specifically, the costs associated with surgery for 7 patient days were $1,602 and $172 for pre-surgery (3 and 39 weeks, respectively); $19,819 for surgery; and $28 for the acute care phase. Attributable costs were lower for patients who underwent surgery in the intermediate and long-term care phases, at −$72 and −$94, respectively.

Investigators also found that the cumulative health costs of surgical treatment were higher than medical treatment in the first 7 years after surgery. (Figure). “However, the cumulative costs of medical therapy increased at a higher rate, such that 8 to 10 years after surgery, the cumulative costs of surgical treatment were lower than those of medical therapy,” notes Dr. Widjaja.

The long-term economic benefits justify the upfront costs

Although the current study looked at healthcare costs at a single pediatric epilepsy center, Dr. Widjaja believes the findings “are generalizable to other centers in Canada, the United States, and other countries.” , in that the high initial costs of epilepsy surgery would be offset by the lower costs of the intermediate and long-term care phases, so that the long-term cumulative costs of surgery would be lower than those of epilepsy surgery. medical therapy.

However, she noted that the magnitude of surgery and medical patient costs would differ from other countries due to differences in healthcare systems.

“The results of this study provide compelling evidence of the long-term economic benefits of surgery over medical therapy for the healthcare system using real data, and therefore justify the high upfront costs of surgery for stakeholders. “, says Dr. Widjaja. .

She also indicated directions for future research based on this work.

“The cost data generated by this study will provide critical data for future economic evaluation comparing minimally invasive treatment, such as MRI-guided interstitial laser heat therapy, to epilepsy surgery,” notes Dr. Widjaja .