Title :

Cost-effectiveness analysis of epilepsy surgery in a controlled cohort of adult patients with intractable partial epilepsy: a 5-year follow-up study

Author(s) :

Picot, Marie-Christine [Auteur]
Jaussent, Audrey [Auteur]
Neveu, Dorine [Auteur]
Kahane, Philippe [Auteur]
Crespel, Arielle [Auteur]
Gelisse, Philippe [Auteur]
Hirsch, Edouard [Auteur]
Derambure, Philippe [Auteur]
Médicaments et molécules pour les systèmes vivants - U 1177 [M2SV]
Médicaments et molécules pour les systèmes vivants - U 1177 [M2SV]
Médicaments et Molécules pour agir sur les Systèmes Vivants (M2SV) - U1177
Dupont, Sophie [Auteur]
Landre, Elisabeth [Auteur]
Chassoux, Francine [Auteur]
Valton, Luc [Auteur]
Vignal, Jean-Pierre [Auteur]
Marchal, Cecile [Auteur]
Lamy, Catherine [Auteur]
Semah, Franck [Auteur]
Troubles cognitifs dégénératifs et vasculaires - U 1171 - EA 1046 [TCDV]
Troubles cognitifs dégénératifs et vasculaires - U1171
Troubles cognitifs dégénératifs et vasculaires - U 1171 - EA 1046 [TCDV]
Biraben, Arnaud [Auteur]
Arzimanoglou, Alexis [Auteur]
Petit, Jerome [Auteur]
Thomas, Pierre [Auteur]
Laboratoire Sciences Cognitives et Sciences Affectives - UMR 9193 [SCALab]
Laboratoire Sciences Cognitives et Sciences Affectives - UMR 9193 [SCALab]
Sciences Cognitives et Sciences Affectives (SCALab) - UMR 9193
Macioce, Valerie [Auteur]
Dujols, Pierre [Auteur]
Ryvlin, Philippe [Auteur]

Journal title :

Epilepsia

Abbreviated title :

Epilepsia

Volume number :

57

Pages :

1669-1679

Publication date :

2016-10-01

ISSN :

0013-9580

English keyword(s) :

Prospective study
Indirect
Direct medical costs
Refractory epilepsy
costs
Incremental cost-effectiveness ratio
Mesh:Delivery of Health Care/methods
Mesh:Young Adult
Mesh:Treatment Outcome
Mesh:Time Factors
Mesh:Statistics
Mesh:Nonparametric
Mesh:Neurosurgical Procedures/methods*
Mesh:Neurosurgical Procedures/economics*
Mesh:Middle Aged
Mesh:Male
Mesh:Humans
Mesh:France
Mesh:Female
Mesh:Adolescent
Mesh:Adult
Mesh:Anticonvulsants/economics
Mesh:Anticonvulsants/therapeutic use
Mesh:Cohort Studies
Mesh:Cost-Benefit Analysis
Mesh:Epilepsies
Mesh:Partial/surgery*
Mesh:Epilepsies
Mesh:Partial/economics*
Mesh:Epilepsies
Mesh:Partial/drug therapy
Mesh:Drug Resistant Epilepsy
Mesh:Delivery of Health Care/economics

HAL domain(s) :

Sciences du Vivant [q-bio]
Sciences cognitives

English abstract : [en]

OBJECTIVE: Despite its well-known effectiveness, the cost-effectiveness of epilepsy surgery has never been demonstrated in France. We compared cost-effectiveness between resective surgery and medical therapy in a controlled ...
Show more >OBJECTIVE: Despite its well-known effectiveness, the cost-effectiveness of epilepsy surgery has never been demonstrated in France. We compared cost-effectiveness between resective surgery and medical therapy in a controlled cohort of adult patients with partial intractable epilepsy. METHODS: A prospective cohort of adult patients with surgically remediable and medically intractable partial epilepsy was followed over 5 years in the 15 French centers. Effectiveness was defined as 1 year without a seizure, based on the International League Against Epilepsy (ILAE) classification. Clinical outcomes and direct costs were compared between surgical and medical groups. Long-term direct costs and effectiveness were extrapolated over the patients' lifetimes with a Monte-Carlo simulation using a Markov model, and an incremental cost-effectiveness ratio (ICER) was computed. Indirect costs were also evaluated. RESULTS: Among the 289 enrolled surgery candidates, 207 were operable-119 in the surgical group and 88 in the medical group-65 were not operable and not analyzed here, 7 were finally not eligible, and 10 were not followed. The proportion of patients completely seizure-free during the last 12 months (ILAE class 1) was 69.0% in the operated group and 12.3% in the medical group during the second year (p < 0.001), and it was respectively 76.8% and 21% during the fifth year (p < 0.001). Direct costs became significantly lower in the surgical group the third year after surgery, as a result of less antiepileptic drug use. The value of the discounted ICER was 10,406 (95% confidence interval [CI] 10,182-10,634) at 2 years and 2,630 (CI 95% 2,549-2,713) at 5 years. Surgery became cost-effective between 9 and 10 years after surgery, and even earlier if indirect costs were taken into account as well. CONCLUSIONS: Our study suggests that in addition to being safe and effective, resective surgery of epilepsy is cost-effective in the medium term. It should therefore be considered earlier in the development of epilepsy.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
CNRS
Inserm
Université de Lille

Collections :

• Lille Neurosciences & Cognition (LilNCog) - U 1172

Research team(s) :

Troubles cognitifs dégénératifs et vasculaires

Submission date :

2019-11-27T14:30:20Z
2019-12-12T08:21:56Z