Economic evaluation of deep brain stimulation compared with vagus nerve stimulation and usual care for patients with refractory epilepsy: A lifetime decision analytic model

Chan, Hoi Yau; Wijnen, Ben; Majoie, Marian; Evers, Silvia M. A. A.; Hiligsmann, Mickaël

doi:10.1111/epi.17158

Cited by 9 publications

(41 citation statements)

References 39 publications

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“…25 Sensitivity analyses were performed by all studies to determine the confidence of their conclusions. The base case probabilistic sensitivity analysis, when performed, showed that the probability of the results being cost-effective were between 84% 27 and 99.7% 28 for epilepsy surgery and between 1% 26 and 99.9% 25 for neurostimulator treatments. Most models were found to be robust (i.e., sensitivity analysis did not alter the conclusions of cost-effectiveness), and the results were only sensitive to extreme variations in input values, beyond the range of uncertainty.…”

Section: Resultsmentioning

confidence: 99%

“…Study Selection, Characteristics, and Quality Ten articles met study eligibility criteria and were included in the final analysis. [22][23][24][25][26][27][28][29][30][31] Study selection workflow is depicted in Figure 1. Year of publication ranged between 1995 and 2022, and study countries/regions included the United States, [22][23][24][25] the EU, 26,28,29 Thailand, 27 England, 30 and Canada.…”

Section: Resultsmentioning

confidence: 99%

“…24 All studies involving neurostimulator interventions sourced RCTs as evidence. 25,26,30 However, they had their own inherent limitations, including using percentage reduction in seizure frequency as their primary outcome, which was challenging to translate into health care resource use and utilities. Second, 3 studies 22,23,31 were published before the 2001 landmark RCT demonstrating the effectiveness of epilepsy surgery, 9 and the authors made many assumptions and used lower quality evidence, such as review of textbooks, expert opinion, and international experience.…”

Section: Discussionmentioning

confidence: 99%

“…Methods of data analysis had a significant effect on the results for one study. 26 Finally, cost-effectiveness must be considered in line with societal WTP thresholds, which vary among countries. The use of higher thresholds, by diseases such as epilepsy with a higher burden of disease, increases the probability that an intervention is cost-effective.…”

Section: Discussionmentioning

confidence: 99%

“…For neurostimulator treatments, factors associated with improved cost-effectiveness included decreased explanation probability, 30 higher inpatient and elective costs, 30 increased health care resource use, 30 higher antiseizure medication use 30 and costs, 25,30 lower device-associated costs, 25,26,30 improved device battery life, 25 and longer time horizon. 26 In 1 study, the results The WTP thresholds included in this table refer to those reported by each original study, which in each case was specific to the country and year, in which the analysis was performed.…”

Section: Key Model Determinantsmentioning

confidence: 99%

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Systematic Review of Cost-Effectiveness Analysis for Surgical and Neurostimulation Treatments for Drug-Resistant Epilepsy in Adults

et al. 2023

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Background and Objectives:Surgical and neurostimulator treatments are effective for reducing seizure burden in selected individuals living with drug resistant epilepsy (DRE). We aimed to determine the presence and key model determinants for cost-effectiveness of these interventions, compared to medical management alone, to assist with decisions about resource allocation.Methods:A systematic literature search was conducted on June 1, 2022, using Medline, Embase, NHS Economic Evaluation Database, and the Cost-Effectiveness Analysis database. Included studies were economic evaluations in adult DRE cohorts; comparing surgical and neurostimulator treatments (vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS)) vs medical management alone; and reporting cost-benefit analysis, cost-utility, or cost-effectiveness. Exclusion criteria were studies with pediatric cohorts and those published in a language other than English. Three independent reviewers screened, extracted, and assessed data against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist, and a fourth reviewer adjudicated discrepancies.Results:Ten studies met inclusion criteria. Seven studies evaluated epilepsy surgery, and three evaluated neurostimulation treatments. All relevant studies established that epilepsy surgery is a cost-effective intervention compared to medical management alone, with regards to quality adjusted life years (QALYs), and seizure freedom at 2- and 5 years. All relevant studies found neurostimulator treatments to be potentially cost-effective. The incremental cost-effectiveness ratio (ICER), with lower ICER indicating greater cost-effectiveness, was reported for nine studies, and varied between GBP £3,013 and US $61,333. Cost adaptation revealed ICERs from US $170 to US $121,726. Key model determinants included, but were not limited to, improved surgical outcomes and quality of life, reduced surgical and presurgical evaluation costs, higher rates of surgical eligibility after referral and evaluation, epilepsy subtype, less expensive neurostimulator devices with improved longevity, and cost analysis strategy used in the analysis.Discussion:There is consistent evidence that epilepsy surgery is a cost-effective treatment for eligible candidates with DRE. Limited evidence suggests that VNS, RNS, and DBS may be cost-effective therapies for DRE, although more health economic evaluations alongside prospective clinical trials are needed to validate these findings.

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