Cost-Effectiveness Analysis of Responsive Neurostimulation for Drug-Resistant Focal Onset Epilepsy
Abstract number :
3.306
Submission category :
9. Surgery / 9A. Adult
Year :
2021
Submission ID :
1826737
Source :
www.aesnet.org
Presentation date :
12/6/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:56 AM
Authors :
Sameer Sheth, MD, PhD - Baylor College of Medicine; Timothy Dyster - UCSF; Casey Halpern - Stanford University; Uma Mahajan - Case Western Reserve University; Guy McKhann - Columbia University; Shraddha Srinivasan - Columbia University; Brett Youngerman - Columbia University
Rationale: We evaluated the incremental cost-effectiveness of responsive neurostimulation (RNS System) therapy for management of medically refractory focal onset seizures compared to pharmacotherapy alone.
Methods: We created and analyzed a decision model for treatment with RNS therapy versus pharmacotherapy using a semi-Markov process. We adopted a public payer perspective and used the maximum duration of 9 years in the RNS long-term follow-up study as the time horizon. We used seizure frequency data to model changes in quality of life and estimated the impact of RNS therapy on the annual direct costs of epilepsy care. The model also included expected mortality, adverse events, and costs related to system implantation, programming, and replacement. We interpreted our results against societal willingness-to-pay thresholds of $50,000, $100,000, and $200,000 per quality-adjusted life year (QALY).
Results: Based on 3 different calculated utility value estimates, the incremental cost-effectiveness ratio (ICER) for RNS therapy (with continued pharmacotherapy) compared to pharmacotherapy alone ranged between $34,867-$56,253. Monte Carlo probabilistic sensitivity analysis yielded ICERs often below $50,000 per QALY and consistently ( >99% of iterations) below $100,000/QALY. Epilepsy care costs associated with seizure frequency had the largest influence on the final ICER in our model; further increases in battery life would significantly reduce the ICER.
Conclusions: Modeling based on 9 years of available data demonstrates that RNS therapy for medically refractory epilepsy very likely falls within the range of cost-effectiveness depending on method of utility estimation, variability in model inputs, and willingness-to-pay threshold. Several factors favor improved cost-effectiveness in the future. Given the increasing focus on delivering cost-effective care, we hope that this analysis will help inform clinical decision-making for this surgical option for refractory epilepsy.
Funding: Please list any funding that was received in support of this abstract.: N/A.
Surgery