Treatment and Follow-up Costs Following Gamma-Knife or Temporal Lobectomy: Results from the ROSE Trial
Abstract number :
1.340
Submission category :
9. Surgery / 9A. Adult
Year :
2018
Submission ID :
504714
Source :
www.aesnet.org
Presentation date :
12/1/2018 6:00:00 PM
Published date :
Nov 5, 2018, 18:00 PM
Authors :
John T. Langfitt, University of Rochester; Guofen Yan, University of Virginia; Mark Quigg, University of Virginia; Nicholas Barbaro, Indiana University; Mariann Ward, University of California - San Francisco; Edward Chang, University of California - San F
Rationale: In case series, minimally-invasive surgery for temporal lobe epilepsy (radiosurgery, laser ablation) has been similarly effective to anterior temporal lobectomy (ATL) in controlling seizures. Minimally-invasive approaches also may be associated with lower health care costs. Methods: We compared direct medical costs and indirect costs over three years of follow-up among patients treated with gamma knife surgery (GKS) and those with ATL in the Radiosurgery vs. Open Surgery for Epilepsy (ROSE) Trial. Trial participants recorded in their seizure diary all episodes of health care utilization and hours of employment lost by patient and caregiver while seeking care during follow-up. Direct medical (treatment and follow-up) costs were calculated using a Medicare-costing approach used in a prior study of the costs of ATL. Costs of AEDs were calculated by applying Redbook 2015 average wholesale prices (AWP) to utilization abstracted from the trial database. Indirect costs (lost productivity) were calculated using national wage rates. Costs and frequency of use were compared using generalized linear models for repeated measures with normal or Poisson distribution as appropriate and log link. Results: Power of all analyses was limited by the small sample and the skewed nature of healthcare cost data. Treatment and follow-up costs (in thousands of US dollars) did not differ significantly between GKS (n=20, mean $76.6, 95% CI 50.7 – 115.6) and ATL (n=18, mean $79.0, 95% CI 60.1 – 103.8). Costs among ATL participants declined over the course of follow-up (p = .005), possibly due to the high initial treatment cost and earlier seizure remission. Costs among GKS participants tended to increase over the first 18 months (p = .17) and declined thereafter (p = .06), possibly due to delay in seizure remission. Indirect costs did not change much over time and there were no differences between the two groups. Conclusions: In this relatively small sample, we did not observe large differences in costs between GKS and ATL, although smaller, meaningful differences may exist. Funding: NIH/NINDS U01 NS 045686 (N. Barbaro, Principal Investigator)