Long-term economic benefits of surgery offset initial cost in children with epilepsy
Click Here to Manage Email Alerts
Surgical therapy yielded lower long-term health care costs compared with medical therapy in children with drug-resistant epilepsy, according to a Canadian study published in Neurology.
“While there is a plethora of evidence supporting the benefits of pediatric epilepsy surgery on improving seizure control at the patient level, less is known about the economic impact to the health care system,” Elysa Widjaja, MD, MPH, of the Institute of Health Policy, Management and Evaluation at the University of Toronto, and colleagues wrote.
Researchers sought to evaluate whether improvement in seizure control following surgery could lead to lower, long-term health care resource use and costs, compared with medical therapy, in children with drug-resistant epilepsy.
They examined more than 600 Canadian children who were evaluated for epilepsy surgery and treated with either surgery (n = 372) or medical therapy (n = 258) from 2003 to 2018 at the Hospital for Sick Children in Toronto.
Researchers assigned patients to pre-surgery, surgery, short-term (first 2 years), intermediate-term (2 to 5 years) and long-term (5 years or more) post-surgery care phases, based on treatment trajectory, and assessed phase-specific and cumulative long-term health care costs. Costs were converted from Canadian to U.S. dollars per the currency value in 2018.
Results showed that costs were higher for surgical vs. medical patients for pre-surgery, surgery and short-term care phases, while costs were lower in surgical patients for intermediate and long-term care phases.
For the surgical cohort, costs were highest for surgery followed by pre-surgery care phase, with hospitalizations accounting for the highest costs. Conversely, in the medical cohort, costs increased gradually from pre-surgery to long-term care-phase. Cumulative costs were higher for surgical vs. medical patients in the first 7 years after surgery, but the trend reversed from 8 years onward.
“We anticipate that our findings are generalizable to other centers outside Canada, in that the initial high cost of epilepsy surgery would be offset by the lower costs of intermediate- and long-term care-phase such that the cumulative long-term costs of surgical patients would be lower compared to medical patients,” Widjaja and colleagues wrote. “However, the magnitude of healthcare costs of surgical and medical patients in our study would differ from other countries due to differences in healthcare system.”