Long‐term reduction of health care costs and utilization after epilepsy surgery

Abstract

SUMMARY Objective To assess long-term direct medical costs, health care utilization, and mortality following resective surgery in persons with uncontrolled epilepsy. Methods Retrospective longitudinal cohort study of Medicaid beneficiaries with epilepsy from 2000 - 2008. The study population included 7,835 persons with uncontrolled focal epilepsy age 18 to 64 years, with an average follow-up time of 5 years. Of these, 135 received surgery during the study period. To account for selection bias, we used risk-set optimal pairwise matching on a time-varying propensity score, and inverse probability of treatment weighting. Repeated measures generalized linear models were used to model utilization and cost outcomes. Cox proportional hazard was used to model survival. Results The mean direct medical cost difference between the surgical group and control group was $6,806 after risk-set matching. The incidence rate ratio of inpatient, emergency room, and outpatient utilization was lower among the surgical group in both unadjusted and adjusted analyses. There was no significant difference in mortality after adjustment. Among surgical cases, mean annual costs per subject were on average $6,484 lower, and all utilization measures were lower after surgery compared to before. Significance Subjects that underwent epilepsy surgery had lower direct medical care costs and health care utilization. These findings support that epilepsy surgery yield substantial health care cost savings.

Seizure outcomes in nonresective epilepsy surgery: an update

“…Cost effectiveness research has suggested that resective epilepsy surgery is more economically effective than continued medical therapy in both children and adults [14,111,128], but few cost effectiveness studies have examined non-resective epilepsy procedures. Ben-Menachem et al performed a retrospective analysis of 43 patients receiving VNS for epilepsy, and concluded that VNS results in annual reduction of approximately 3,000 dollars (in 2002 U.S. currency) in unplanned hospital costs per patient [9].…”

Identifying Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization

“…Other approaches have used multivariable models to model health expenditures and utilization by multiple individual conditions. 11,12 The limitation with this approach is that it assumes an additive relationship and does not account for the effect of possible nonlinear, non-additive co-occurrence of these conditions. Most importantly, given the reliance of most previous studies on administrative claims data alone, multimorbidity has been equated with multiple chronic conditions, without recognizing the simultaneous presence of functional limitations and geriatric syndromes, which are highly prevalent in older adults.…”

Epilepsy surgery in low- and middle-income countries: A scoping review

“…In view of the high burden of epilepsy in LMIC, it is debated whether surgery may be a costeffective long-term investment that may benefit more people in the long run [188]. Studies evaluating the costs of surgical versus medical treatment observed that although surgical treatment requires a large initial expenditure it was superior because of the greater seizure-free rate, with the long term cost-analysis favoring surgery as the cost-time curves intersect in a few years [189][190][191]. These costanalyses comparing medical and surgical therapy of epilepsy should be interpreted with caution since the cost of surgery and benefit gained by seizure reduction are not linear and that measuring just the reduction in seizure frequency in the short-term is inadequate to compare costs.…”