Abstracts

In a multicenter cohort, intractable epileptic patients, candidates for resective surgery were followed to compare surgical and medical therapy in a cost-effectiveness analysis. The pre-surgical explorations and surgery costs will be detailed. Adult patients with a partial medically intractable epilepsy, potentially operable were eligible and followed every 6 months over two years at least. The effectiveness was defined as one year without seizure. We assessed the incremental cost-effectiveness ratio for the first two years after surgery with a societal perspective. The long-term costs and effectiveness were extrapolated over the patients[apos]lifetime with a Markov model. 289 patients were included (106 with surgery, 163 medically treated, 7 not eligible, 13 lost of follow-up). Disease was more severe in surgical than in medical patients: seizure frequency, depressive disorders and cognitive impairment were greater. The mean cost of pre-surgical explorations was 8303 [euro] and 21 142 [euro] for explorations and surgery. One and two years after the surgery, respectively 81.8% and 78.9% of patients were seizure free. For medically treated patients, the annual total direct cost raised to 3858 [euro]. During the first year after surgery, the mean direct costs was 6449 [euro] and mainly due to hospitalization. During the second year, the mean direct costs was 2481 [euro], the cost of antiepileptic drugs predominated. One year without seizure cost 29433 [euro] the first year after surgery, and 13180 [euro] the second year. In a long-term perspective, the surgery became cost-effective in a delay of 8 years. Surgical therapy was cost-effective in the middle-term even if indirect costs are not taken into account. (Supported by CHU Montpellier (PHRC 1998) and Pfizer.)