Cost-effectiveness of surgery for drug-resistant temporal lobe epilepsy in the US
Cost-effectiveness of surgery for drug-resistant temporal lobe epilepsy in the US
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DOI：
10.1212/wnl.0000000000010185
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发表时间：
2020-09-08
期刊：
影响因子：
9.9
通讯作者：
Jehi, Lara
中科院分区：
文献类型：
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作者：
Sheikh, Shehryar R.;Kattan, Michael W.;Jehi, Lara
目的手术治疗难治性颞叶癫痫（DR-TLE）是一种有效但昂贵的治疗方法。我们的目的是评估，在美国，手术是否具有成本效益相比，医疗管理的患者被视为手术候选人和手术评估是否具有成本效益的DR-TLE患者一般。方法我们使用半马尔可夫模型来评估手术的成本效益和手术评价在一生的时间跨度。我们使用二阶蒙特卡罗模拟进行概率敏感性分析，以估计模型输出的变化。我们采用医疗保健和社会观点，包括直接医疗保健成本（例如，手术，抗癫痫药物）和间接费用（例如，患者和护理提供者的收入损失。我们将增量成本效果比与社会支付意愿（类似于每质量调整生命年10万美元[QALY]）进行比较，以确定手术是否具有成本效益。结果癫痫手术是符合手术条件的患者相比，医疗管理的成本效益，凭借节省成本（328,000美元对423,000美元）和更有效（16.6对13.6 QALY），从长远来看，比医疗管理。手术评估是具有成本效益的患者DR-TLE，即使被认为是一个手术候选人的概率只有5%。从社会的角度来看，手术在3年内变得具有成本效益，89%的模拟支持终身手术。结论对于符合手术条件的DR-TLE患者，手术是经济有效的。对于一般的DR-TLE患者，转诊进行手术评估（以及可能的后续手术）具有成本效益。DR-TLE患者应毫不犹豫地根据成本效益进行手术评估。
Objective Surgery is an effective but costly treatment for many patients with drug-resistant temporal lobe epilepsy (DR-TLE). We aim to evaluate whether, in the United States, surgery is cost-effective compared to medical management for patients deemed surgical candidates and whether surgical evaluation is cost-effective for patients with DR-TLE in general. Methods We use a semi-Markov model to assess the cost-effectiveness of surgery and surgical evaluation over a lifetime horizon. We use second-order Monte Carlo simulations to conduct probabilistic sensitivity analyses to estimate variation in model output. We adopt both health care and societal perspectives, including direct health care costs (e.g., surgery, antiepileptic drugs) and indirect costs (e.g., lost earnings by patients and care providers.) We compare the incremental cost-effectiveness ratio to societal willingness to pay (similar to$100,000 per quality-adjusted life-year [QALY]) to determine whether surgery is cost-effective. Results Epilepsy surgery is cost-effective compared to medical management in surgically eligible patients by virtue of being cost-saving ($328,000 vs $423,000) and more effective (16.6 vs 13.6 QALY) than medical management in the long run. Surgical evaluation is cost-effective in patients with DR-TLE even if the probability of being deemed a surgical candidate is only 5%. From a societal perspective, surgery becomes cost-effective within 3 years, and 89% of simulations favor surgery over the lifetime horizon. Conclusion For surgically eligible patients with DR-TLE, surgery is cost-effective. For patients with DR-TLE in general, referral for surgical evaluation (and possible subsequent surgery) is cost-effective. Patients with DR-TLE should be referred for surgical evaluation without hesitation on cost-effectiveness grounds.