Eur J Neurol. 2022 Nov 12. doi: 10.1111/ene.15632. Online ahead of print.
ABSTRACT
BACKGROUND: Approximately 30% of epilepsy patients develop a drug-refractory epilepsy (DRE), i.e., 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.
METHODS: A systematic literature search was performed in MEDLINE, EMBASE, PsycINFO, Cochrane Library, and NHS EED until September 2022. Title, abstract, and full-text screening were conducted by two researchers. We included original studies published in English or German analyzing the cost-effectiveness of surgical compared to medical treatment. Study characteristics, effectiveness measures, costs, and incremental cost-effectiveness ratios (ICERs) were extracted. The quality of studies was assessed using the Drummond checklist.
RESULTS: 14 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 4,202 and the ICER per QALY 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. We conclude 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 DRE.
PMID:36371643 | DOI:10.1111/ene.15632
