Cost-effectiveness analysis of invasive EEG monitoring in drug-resistant epilepsy
Cost-effectiveness analysis of invasive EEG monitoring in drug-resistant epilepsy
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DOI：
10.1016/j.yebeh.2020.107488
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发表时间：
2021-01-15
影响因子：
2.6
通讯作者：
Zemplenyi, Antal
中科院分区：
文献类型：
--
作者：
Kovacs, Sandor;Toth, Marton;Zemplenyi, Antal
目的：我们的目的是确定两种颅内脑电图（iEEG）干预措施的成本效益：1)立体脑电图（SEEG）和2)硬膜下网格电极（SDGs）的放置都是在切除手术之后，从付款人的角度与匈牙利的医疗管理（MM）进行比较。方法：在成本效用分析（CUA）中，结合决策树和流行马尔可夫过程模型，确定了30年时间范围内iEEG干预措施的增量健康收益和成本。为了解决参数不确定性对增量成本-效果比（ICER）的影响，进行了确定性和概率敏感性分析。结果：我们的研究结果表明，SEEG和SDG干预措施都比代表当前护理标准的MM更昂贵，但更有效。与MM相比，SEEG和SDG的总折扣成本分别为（sic） 32,760和（sic） 25,028，分别为（sic） 18,108和（sic） 10,375。而SEEG组和SDG组分别提供了3.931年和3.444年的质量调整生命年。因此，与MM相比，SEEG的ICER为每QALY增益（sic） 4607，而SDG的ICER为每QALY增益（sic） 3013。在匈牙利，每QALY的成本效益阈值为41,058，iEEG干预的两种亚型都具有成本效益，并且物有所值。意义：由于植入电极和监测的高成本，目前在匈牙利国家卫生保健系统中还没有难治性癫痫患者的有创脑电图。我们的研究表明，与MM相比，匈牙利的这些程序具有成本效益。因此，开始将iEEG干预措施引入国家健康保险基金管理局的报销清单。(C) 2020作者。Elsevier Inc.出版。
Purpose: Our aim was to determine the cost-effectiveness of two intracranial electroencephalography (iEEG) interventions: 1) stereo electroencephalography (SEEG) and 2) placement of subdural grid electrodes (SDGs) both followed by resective surgery in patients with drug-resistant, partial-onset epilepsy, compared with medical management (MM) in Hungary from payer's perspective.Methods: The incremental health gains and costs of iEEG interventions have been determined with a combination of a decision tree and prevalence Markov process model over a 30-year time horizon in a cost-utility analysis (CUA). To address the effect of parameter uncertainty on the incremental cost-effectiveness ratio (ICER), deterministic and probabilistic sensitivity analyses were performed.Results: Our results showed that both SEEG and SDG interventions represent a more expensive but more effective strategy than MM representing the current standard of care. The total discounted cost of SEEG and SDG were (sic) 32,760 and (sic) 25,028 representing (sic) 18,108 and (sic) 10,375 additional cost compared with MM, respectively. However, they provide an additional 3.931 (in SEEG group) and 3.444 quality-adjusted life years (QALYs; in SDG group), correspondingly. Thus, the ICER of SEEG is (sic) 4607 per QALY gain, while the ICER for SDG is (sic) 3013 per QALY gain, compared with MM. At a cost-effectiveness threshold of (sic) 41,058 per QALY in Hungary, both subtypes of iEEG interventions are cost-effective and provide good value for money.Significance: Because of the high cost of implanting electrodes and monitoring, the invasive EEG for patients with refractory epilepsy is currently not available in the Hungarian national healthcare system. Our study demonstrated that these procedures in Hungary are cost-effective compared with the MM. As a result, the introduction of iEEG interventions to the reimbursement list of the National Health Insurance Fund Administration was initiated. (C) 2020 The Author(s). Published by Elsevier Inc.