Abstract
Objective: To determine whether a less-invasive approach to surgery for medically refractory temporal lobe epilepsy is associated with lower health care costs and costs of lost productivity over time, compared to open surgery. Methods: We compared direct medical costs and indirect productivity costs associated with treatment with stereotactic radiosurgery (SRS) or anterior temporal lobectomy (ATL) in the ROSE (Radiosurgery or Open Surgery for Epilepsy) trial. Health care use was abstracted from hospital bills, the study database, and diaries in which participants recorded health care use and time lost from work while seeking care. Costs of use were calculated using a Medicare costing approach used in a prior study of the costs of ATL. The power of many analyses was limited by the sample size and data skewing. Results: Combined treatment and follow-up costs (in thousands of US dollars) did not differ between SRS (n = 20, mean = $76.6, 95% confidence interval [CI] = 50.7-115.6) and ATL (n = 18, mean = $79.0, 95% CI = 60.09-103.8). Indirect costs also did not differ. More ATL than SRS participants were free of consciousness-impairing seizures in each year of follow-up (all P < 0.05). Costs declined following ATL (P = 0.005). Costs tended to increase over the first 18 months following SRS (P = 0.17) and declined thereafter (P = 0.06). This mostly reflected hospitalizations for SRS-related adverse events in the second year of follow-up. Significance: Lower initial costs of SRS for medial temporal lobe epilepsy were largely offset by hospitalization costs related to adverse events later in the course of follow-up. Future studies of less-invasive alternatives to ATL will need to assess adverse events and major costs systematically and prospectively to understand the economic implications of adopting these technologies.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1453-1461 |
| Number of pages | 9 |
| Journal | Epilepsia |
| Volume | 60 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 2019 |
Bibliographical note
Funding Information:This project was funded by the National Institutes of Health National Institute of Neurological Disorders and Stroke (R01 NS 058634‐01A2) and Elekta, Stockholm, Sweden. The following individuals and institutions contributed to participant recruitment, treatment, and study management: Sarat Chandra, MD, Shashank K. Kale, MD, Ashima N. Washawan, PhD (All India Institute of Medical Science, New Delhi, India); Adam Hebb, MD (Colorado Neurological Institute, Denver, CO); Hyunmi Choi, MD, Catherine Schevon, MD, Gail Iodice, RN (Columbia University, New York, NY);
Funding Information:
This project was funded by the National Institutes of Health National Institute of Neurological Disorders and Stroke (R01 NS 058634-01A2) and Elekta, Stockholm, Sweden. The following individuals and institutions contributed to participant recruitment, treatment, and study management: Sarat Chandra, MD, Shashank K. Kale, MD, Ashima N. Washawan, PhD (All India Institute of Medical Science, New Delhi, India); Adam Hebb, MD (Colorado Neurological Institute, Denver, CO); Hyunmi Choi, MD, Catherine Schevon, MD, Gail Iodice, RN (Columbia University, New York, NY); Robert Goodman, MD (Icahn School of Medicine at Mount Sinai, New York, NY) Cyndi Herrera (Indiana University, Indianapolis, IN); Robert Beach, MD (State University of New York, Upstate, Syracuse, NY); Lawrence ver Hoef, MD (University of Alabama at Birmingham, Birmingham, AL); William P. Dillon, MD, Kathleen Lamborn, PhD, Lijun Ma, PhD (University of California, San Francisco, San Francisco, CA); Aviva Abosch, MD (University of Colorado, Aurora, CO); Thomas Pittman, MD (University of Kentucky, Lexington, KY); Douglas Kondziolka, MD (New York University Langone Medical Center, New York, NY); Rick Hendrickson, PhD (University of Pittsburgh, Pittsburgh, PA); Beate Diehl, MD (University of Sheffield, Sheffield, UK); Charles Y. Liu, MD, Laura Kalayjian, MD (University of Southern California, Los Angeles, CA); Stacy Thompson, RN, W. Jeffery Elias, MD, Jason Sheehan, MD (University of Virginia, Charlottesville, VA); and Jeffrey Ojemann, MD (University of Washington, Seattle, WA).
Publisher Copyright:
Wiley Periodicals, Inc. © 2019 International League Against Epilepsy
Keywords
- costs
- epilepsy
- health care
- lobectomy
- radiosurgery