Abstract
Objective. Surgery for medically refractory epilepsy (MRE) in adults has been shown to be effective but underutilized. Comprehensive health economic evaluations of surgery compared with continued medical management are limited. Policy changes may be necessary to influence practice shift. Methods. A critical review of the literature on health economic analyses for adults with MRE was conducted. The MEDLINE, EMBASE, CENTRAL, CRD, and EconLit databases were searched using relevant subject headings and keywords pertaining to adults, epilepsy, and health economic evaluations. The screening was conducted independently and in duplicate. Results. Four studies were identified (1 Canadian, 2 American, and 1 French). Two were cost-utility analyses and 2 were cost-effectiveness evaluations. Only one was conducted after the effectiveness of surgery was established through a randomized trial. All suggested surgery to be favorable in the medium to long term (7-8 years and beyond). The reduction of medication use was the major cost-saving parameter in favor of surgery. Conclusions. Although updated evaluations that are more generalizable across settings are necessary, surgery appears to be a favorable option from a health economic perspective. Given the limited success of knowledge translation endeavours, funder-level policy changes such as quality-based purchasing may be necessary to induce a shift in practice.
Highlights
At an approximate global prevalence of 1%, epilepsy is among the most common serious neurological disorders worldwide [1]
Costs (1993 Canadian dollars) are comprised of antiepileptic drugs (AEDs), perioperative care, presurgical evaluation, and physician fees. These were obtained through surveying a small sample of the regional epilepsy population, assessment of the local patient cohort, hospital cost database, and physician reimbursement fees
Four health economic evaluations of surgery for medically refractory epilepsy (MRE) were identified through a systematic review, only one of which had been conducted following the RCT by Wiebe et al [5]
Summary
At an approximate global prevalence of 1%, epilepsy is among the most common serious neurological disorders worldwide [1]. Despite evidence in favor of the effectiveness of surgery for medically refractory epilepsy (MRE) [2,3,4,5,6], referral rates for evaluation of surgical candidacy are low [7,8,9,10]. The economic impact of epilepsy should not be underestimated. The direct costs account for 25% of the societal economic burden [1, 11, 12]. There are indirect [12,13,14] and intangible costs [15]. Seizure frequency has been shown to have a direct correlation with resource
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