OBJECTIVES : To compare healthcare utilization following surgical or medical treatment for children with refractory epilepsy

METHODS : We extracted hospitalized children with epilepsy from the Pediatric Health Information System database using five published algorithms. Refractory epilepsy (RE) patients treated with either antiepileptic medications (AEDs) only or AEDs plus epilepsy surgery (ES) between 1/1/2008 and 12/31/2014 were included. Patients with a history of ES before 1/1/2008 or a vagus nerve stimulation implantation surgery were excluded. ICD-9-CM codes were used to identify ES. Healthcare utilization following the index date at 2- and 5- years including inpatient, emergency department (ED), and all epilepsy-related visits were evaluated. The propensity scores (PS) method was used to match surgically and medically treated patients. Covariates associated with the probability of receiving surgical treatment were chosen in the logistic regression model for calculating PS. SAS® 9.4 and Stata 14.0 were used for data management and statistical analysis.

RESULTS : 10089 (82.8%) and 2083 (17.2%) were surgically and medically treated, respectively. Significant variations of subgroup distribution in age, race, insurance, sources of admission, primary diagnosis, and pediatric complex chronic conditions (p<0.001 for all binary tests) were identified between two groups. 4050 matched cases, 2025 per each treated group, were included. Compared to medically treated patients, utilization was reduced in the surgical group: at 2- and 5- years post-index date, there was a reduction of 40% and 42% of inpatient visits and 46% and 49% of ED visits. The total number (inpatient, ED, ambulatory visits) of epilepsy-associated visits were also reduced by 42%-45% in the surgical group compared to medically-treated group. In those who had surgery, the average reduction in AEDs was 16% at 2- and 5- years after treatment.

CONCLUSIONS : Patients with refractory epilepsy treated with surgery had significant reductions in healthcare utilization compared with matched patients treated with antiepileptic medications only.