Long Term Video-EEG Monitoring of Patients Referred by Refractory Epilepsy in an Epilepsy Unit of a Tertiary Hospital: Clinical Effectiveness and Economic Evaluation
Abstract number :
2.007
Submission category :
3. Neurophysiology / 3A. Video EEG Epilepsy-Monitoring
Year :
2021
Submission ID :
1826082
Source :
www.aesnet.org
Presentation date :
12/9/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:51 AM
Authors :
Juan Luis Becerra-Cuñat, MD,PhD - Hospital Germans Trias i Pujol; Jordi Ciurans, MD – Neurology – Hospital Germans Trias; Antoni Dávalos, MD,PhD – Hospital Director, Hospital Germans Trias; Borja Garcia-Lorenzo, PhD – Health assessments – Kronikgune; Laia Grau-López, MD,PhD – Neurology – Hospital Germans Trias; Marta Jimenez, MD – Neurology – Hospital Germans Trias; Rodrigo Rocamora, MD,PhD – Director of Epilepsy Unit, Neurology, Hospital del Mar
Rationale: Long-term video-EEG monitoring (LTVEEG-m) is the test of certainty in the diagnosis of epilepsy. The European Commission recommends one specialized center with LTVEEG-m and epilepsy surgery for every 3,000 patients with refractory epilepsy (RE). In Spain in 2019 there was one center accredited every 10,600 patients with RE. This study aims to analyze the use of LTVEEG-m versus no LTVEEG-m in RE patients in terms of safety, clinical effectiveness, efficiency, and economic feasibility in Spain.
Methods: Between November 2007 and May 2017, information was collected from a prospective cohort referred to LTVEEG-m. The design was a before-after study and a comparison of the variables before and one year after LTVEEG-m was performed. Safety: Medical complications during admission were performed. Clinical effectiveness: Patients were compared regarding the certainty diagnosis after LTVEEG-m. Economic evaluation: A full economic assessment of health outcomes and costs of LTVEEG-m vs. no LTVEEG-m, treatment based exclusively on antiepileptic drugs (ASD) were conducted. The cost-effectiveness analysis was implemented using a decision tree together a Markov model. Quality Adjusted Years of Life (QALY) were used as an effective measure.
Results: 278 patients with one-year follow-up were included. Safety: The rate of medical complications was 7.2%. A higher likelihood of complications was observed in patients with a higher number of seizures (OR 1.04; 95% CI: 1.02–1.06, 0.002), with five or more seizures with an area under the curve (AUC) of 0.76 p-0.04 and with two or more tonic-clonic seizures with AUC of 0.77, p-0.02. Effectiveness: After LTVEEG-m a diagnostic change (46.9%) and a therapeutic change (59.4%) was determined. The group with a change in diagnosis showed a further reduction in seizure frequency (p- 0.03), in number of ASD ( p-0.001) and a greater improvement in quality of life (p-0.006) at one year compared to the group without changes. Efficiency: LTVEEG-m vs. no LTVEEG-m group, present an estimate average incremental cost of 17,472 Euros per patient and an incremental effectiveness of 8 QALY, generating a cost effectiveness ratio (ICER) of 2,175 Euros per QALY, lower than the cost effectiveness threshold (CE threshold) of 20,000 Euros per QALY in Spain. The sensitivity analysis offered robustness to the ICER. The probability that LTVEEG-m is a CE technology against no LTVEEG-m, according to the CE threshold in Spain, was 100%.
Conclusions: LTVEEG-m is a safe, effective and efficient health technology compared to no LTVEEG-m. Its financing and implementation is recommended. This is a pioneering study in Europe, whose scalability allows its results to be considered in economies similar to the Spanish one.
Funding: Please list any funding that was received in support of this abstract.: No funding was received for this study.
Neurophysiology