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Health care resource utilization and costs before and after epilepsy surgery

Published:November 25, 2022DOI:https://doi.org/10.1016/j.seizure.2022.11.012

      Highlights

      • Descriptive study of epilepsy surgery in privately-insured patients in the USA in the period 2006–2019.
      • Only a minority of patients with refractory epilepsy underwent epilepsy surgery and the proportion has barely changed from 2006 to 2019.
      • StereoEEG has progressively substituted subdural electrodes as the preferred form of long-term intracranial monitoring.
      • The median healthcare costs per person-year decreased by 59% after resective epilepsy surgery ($7,691 versus $18,750).
      • The median healthcare costs per person-year decreased by 51% after hemispherectomy ($26,834 versus $54,596).

      Abstract

      Objective

      To describe the demographics of epilepsy surgery utilization and its impact on health care resource use.

      Methods

      Retrospective descriptive study using the MarketScan commercial claims database. We studied children and adults who underwent epilepsy surgery in the USA in the period 2006-2019. Our main outcome was health care resource utilization.

      Results

      Among the 87,368 patients with refractory epilepsy, 2,011 (2.3%) patients underwent resective epilepsy surgery, 188 (0.2%) patients underwent partial or total hemispherectomy, and 183 (0.2%) patients underwent corpus callosotomy. The proportion of patients undergoing epilepsy surgery has barely increased in the period 2006 to 2019. The year of resective epilepsy surgery was associated with high healthcare costs per person-year [median (p25-p75): $140,322 ($88,749-$225,862)], but healthcare costs per person-year substantially decreased in the 5 years after compared to the 5 years before the year of resective epilepsy surgery [$7,691 ($2,738-$22,092) versus $18,750 ($7,361-$47,082), p-value < 0.0001]. This result held in all resective epilepsy surgery subgroups: children, adults, temporal, extratemporal, subdural EEG monitoring, stereoEEG monitoring, and no intracranial monitoring. Similarly, the year of hemispherectomy was associated with high healthcare costs per person-year [$260,983 ($154,791-$453,986)], but healthcare costs per person-year substantially decreased in the 5 years after compared to the 5 years before the year of hemispherectomy [$26,834 ($12,842-$52,627) versus $54,596 ($19,547-$136,412), p-value < 0.0001]. In contrast, the year of corpus callosotomy was associated with high healthcare costs per person-year [$162,399 ($108,150-$253,156)], but healthcare costs per person-year did not substantially decrease in the 5 years after than in the 5 years before the year of corpus callosotomy [$25,464 ($10,764-$69,338) versus $36,221 ($12,841-$85,747), p-value = 0.2142].

      Conclusion

      In privately insured patients in the USA, resective epilepsy surgery and hemispherectomy substantially decrease healthcare utilization in subsequent years. Epilepsy surgery may help contain costs in the field of epilepsy.

      Keywords

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