Abstracts

Rationale: Epilepsy surgery is an important treatment option in pediatric drug-resistant epilepsy. The associated expense of presurgical evaluation and surgical intervention is thought to be mitigated by subsequent decreased hospitalizations and improvement in quality of life, but this has not been well studied. This study compared health care costs of surgical versus medical management of children with drug-resistant epilepsy at a mid-Western US children's hospital, analyzed trends in health care costs pre- and post-operatively, and evaluated change in seizure frequency. Methods: Included patients were evaluated for epilepsy surgery between 2008 and 2010, were 0-21 years old, and were considered surgical candidates. Cost data were derived from the institution's electronic medical records and cost accounting systems, and included: epilepsy-related outpatient clinic visits, outpatient laboratory and radiographic studies, outpatient anti-epileptic drugs (AEDs), and epilepsy-related inpatient hospitalizations. Data analysis was performed using SAS ® v9.3, specifically two-tailed t-tests to compare between-group demographic variables and costs, and the paired t-test to compare the change in seizure frequency. For categorical variables, Fisher's Exact Test was used to compare group frequencies. Results: There were 93 subjects in the surgical group (48% female); 20 in the medical group (55% female). The average age of seizure onset and the average number of AEDs used in the past for the medical and surgical group were not significantly different (3.1 vs 3.8 years, p=0.69; 4.3 vs 3.6 AEDs, p=0.4). Total estimated annual cost at 1-year follow-up was not significantly different between the medical and surgical group when the cost of the surgical procedure was excluded from the surgical group (USD20123 vs 20717, p=0.938). The average cost of surgery was USD226606, and the average length of stay for epilepsy surgery was 10.6 days. Therefore, when adding the total average cost of epilepsy surgery, the estimated annual cost at 1-year follow-up for the surgical group was USD247323. In the surgical group, 74% of subjects had an ILAE seizure outcome classification of 1, 2, or 3 at 1-year follow-up. There was a significant change in daily seizure frequency in the surgical group (2.7 fewer, p=0.005), but not in the medical group (1.4 fewer, NS). Conclusions: This study is important because it is one of the only studies to systematically compare the costs of medical and surgical management of pediatric drug-resistant epilepsy in the US. Prior studies have evaluated epilepsy surgery costs, but they were conducted in Canada, which has a very different healthcare system and cost structure. The cost of epilepsy surgery is higher than medical management at 1-year follow-up. Further analysis is necessary to determine if seizure control may play a role in the cost effectiveness of surgery over a longer duration of follow-up. Also, the largest contributions to the cost of surgery are from areas with the best potential for cost reduction including room/board, EEG monitoring, AEDs, and decreasing the length of hospital stay.