Economic Evaluation of a Seizure Detection Device for Refractory Epilepsy

OBJECTIVES: Sudden unexpected death in epilepsy (SUDEP) is a leading cause of death in epilepsy patients with refractory seizures. It is postulated that SUDEP is associated with clinically relevant physiological changes, including seizure and cardiorespiratory dysfunction, in the weeks prior to the collapse. We conducted an early economic evaluation and explored clinical characteristics of a wearable system that can monitor and alert for seizures and cardiorespiratory dysfunctions, such as those under development at Neurava Inc.

METHODS: We conducted an economic evaluation by developing a lifetime Markov model that quantifies transitions between years with and without recurrent seizures in refractory epilepsy patients. We analyzed different parameters of seizure detection devices with distinct characteristics over different target populations. We modeled reductions in rates of outpatient visits, epilepsy monitoring unit admissions, emergency room (ED) visits, and hospitalizations associated with the device. We also modeled a false positive (FP) rate for the device. We quantified the cost-effectiveness ratio by calculating the incremental costs over incremental quality-adjusted life years (QALYs). Input parameters of the model were informed from published literature.

RESULTS: When applied to refractory epilepsy patients with an average annual rate of 3.6 ED visits per patient, we found a seizure detection device that 1) costs $1,000 per patient-year, 2) reduces rate of ED visits by 10%, 3) reduces rates of outpatient visits and hospitalizations by 20%, and 4) has a false positive rate of 5%, would improve quality of life and reduce societal costs over the lifetime of a patient. Such a device would further provide value for money at the willingness-to-pay threshold of $100,000/QALY, if the device reduces rates of ED visits and hospitalizations by 10% and outpatient visit by 30%.

CONCLUSIONS: For refractory epileptic patients with recurrent seizures, a wearable seizure detection device could be potentially cost-effective from a societal perspective.