Marie-Christine Picot1,2, Audrey Jaussent3, Dorine Neveu4,5, Philippe Kahane6,7, Arielle Crespel8, Philippe Gelisse8, Edouard Hirsch9, Philippe Derambure10, Sophie Dupont11, Elizabeth Landré12, Francine Chassoux12, Luc Valton13, Jean-Pierre Vignal14, Cécile Marchal15, Catherine Lamy16, Franck Semah10,12,16, Arnaud Biraben17, Alexis Arzimanoglou18, Jérôme Petit19, Pierre Thomas20, Valérie Macioce3, Pierre Dujols3,4,5, Philippe Ryvlin21,22,23. 1. Clinical Research and Epidemiology Unit, CHU Montpellier, Montpellier, France. mc-picot@chu-montpellier.fr. 2. INSERM, Clinical Investigation Center 1411, Montpellier, France. mc-picot@chu-montpellier.fr. 3. Clinical Research and Epidemiology Unit, CHU Montpellier, Montpellier, France. 4. INSERM U 1058, Montpellier, France. 5. University Montpellier, Montpellier, France. 6. Department of Neurology, GIN, CHU Grenoble, Grenoble, France. 7. INSERM U836, UJF, Grenoble Alpes University, Grenoble, France. 8. Epilepsy Unit, CHU Montpellier, Montpellier, France. 9. Department of Neurology, CHU Strasbourg, Strasbourg, France. 10. Lille University Medical Center, CHU Lille, EA 1046, University of Lille2, Lille, France. 11. Epileptology Unit, Assistance Publique-Hôpitaux de Paris, an UPMC University Paris 06, Paris, France. 12. Department of Neurosurgery, AP-HP and University Paris Descartes, Paris, France. 13. Department of Neurology, University Hospital, and UMR 5549, CNRS, Toulouse, France. 14. Clinical Neurophysiology and Epileptology Department, University Hospital of Nancy, Nancy, France. 15. Epilepsy Unit, CHU Bordeaux, Bordeaux, France. 16. Department of Neurology, AP-HP and University Paris Descartes, Paris, France. 17. Department of Neurology, University Hospital of Rennes, Rennes, France. 18. Epilepsy, Sleep and Paediatric Neurophysiology Department (ESEFNP), University Hospitals of Lyon (HCL) and DYCOG Team, Lyon Neuroscience Research Centre (CRNL), INSERM U1028, CNRS UMR 5292, Lyon, France. 19. La Teppe Epilepsy Center, Tain l'Hermitage, France. 20. Department of Neurology, University Hospital of Nice, Nice, France. 21. Department of Functional Neurology and Epileptology and the Institute of Epilepsies, Hospices Civils de Lyon, Lyon, France. 22. Lyon 1 University; Lyon's Neuroscience Research Center, Lyon, France. 23. Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland.
Abstract
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. SIGNIFICANCE: 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. Wiley Periodicals, Inc.
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. SIGNIFICANCE: 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. Wiley Periodicals, Inc.
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