Abstracts

RATIONALE: Treatment options for patients with refractory seizures include conservative therapy with antiepileptic drugs (AEDs) only, epilepsy surgery (ES) or vagus nerve stimulation (VNS). This study compares epilepsy-related direct medical costs before (ERDMC-pre) and after (ERDMC-post) patients underwent these different treatment modalities. METHODS: Prospective data were available in 84 presurgical patients evaluated between 4/95 and 6/99. 24 patients (29%) received AEDs only; 35 (40%) underwent ES; and 25 (30%) had VNS. Seizure frequency, ERDMC-pre and ERDMC-post were assessed prospectively throughout the study. ERDMC-pre and ERDMC-post were compared in and among the different treatment groups. RESULTS: In conservatively treated patients, mean seizure frequency changed from 9 to 8/month while ERDMC changed from 2216 Euro to 2720 Euro. In surgical patients, mean seizure frequency changed from 6 to 1/month; mean ERDMC per year changed from 1521 Euro preoperatively to 1161 Euro postoperatively. In the VNS group, mean seizure frequency changed from 21 to 7/month. In this subgroup ERDMC changed from 5423 Euro to 2804 Euro. Differences in mean seizure frequency changes were significant when conservatively treated patients were compared with both surgical and VNS patients (Mann-Whitney U-test; p=0.0016). ERDMC differences in conservatively treated patients versus both surgical and VNS patients were also statistically significant (Mann-Whitney U-test; p<0.001 and p=0.0037 respectively). CONCLUSIONS: Ongoing daily treatment of patients who underwent resective surgery costs significantly less than conservative treatment and VNS. For patients in whom resective surgery is not an option, ERDMC are significantly lower in VNS treated versus conservatively treated patients. (Supported by Grant BOZF 01105399 from Ghent University; Grant 1.5.236.99 from the Fund for Scientific Research-Flanders and Clinical Epilepsy Grant 1998-2000)