Comparison of Implant Surgery and Readmissions Costs for DBS and VNS

OBJECTIVES: Epilepsy affects all ages and is a common, disabling serious neurological disease often associated with comorbidities. The disease presents a heavy clinical, economic, and societal burden with a continued treatment gap that deserves the attention of healthcare decision-makers. A considerable number of patients do not respond satisfactorily to drug treatment and/or are ineligible for resective epilepsy surgery. Implant surgery offers a therapeutic option for these patients. Deep Brain Stimulation (DBS) and Vagus Nerve Stimulation (VNS) are neuromodulation devices that intervene directly in neural circuits and present interesting clinical results in seizure control.

METHODS: A Brazilian supplemental health data sample was assessed with the objective of evaluating the cost of DBS and VNS procedures. For a sample of 812 surgeries, 43.6% (354) were related to DBS and 56.4% (458) to VNS.

RESULTS: It was found that average surgery costs for DBS were 204% higher, with more than twice the number of in-hospital days for those patients compared to VNS treatment. The average cost of ICU stay for DBS was 49% higher than that of VNS, which might indicate the more invasive technique, complexity, and complications associated with DBS placement. Surgery complications showed that 20.1% of DBS patients presented with readmission events. This is compared with 0.9% of patients who received VNS.

CONCLUSIONS: Accordingly, patients utilizing DBS had higher expenses than those using VNS based on overall surgical procedure cost(s) and readmissions six months post-index surgery. This may be indicative of the more invasive surgical technique, and post-surgical care and follow-up. In this analysis, VNS is associated with a reduction of hospitalizations and costs in drug-resistant epilepsy treatment. VNS may be an alternative for payers to consider when evaluating short-term costs, even with a higher isolated device cost compared to DBS.