OBJECTIVES

To evaluate the cost-effectiveness of Deep Brain Stimulation (DBS) compared to vagus nerve stimulation (VNS) and the continuation of antiepileptic drugs (AED) for the management of drug-refractory epilepsy characterized by partial onset seizures, in Colombia.

METHODS

A Markov model was developed from a payer perspective, using a time horizon of 15 years. Health states included: seizure freedom, responders, non-responders, worsening on treatment, and worsening off treatment. Clinical data was collected from the SANTE Study, including baseline patient characteristics, effectiveness and adverse events. Effectiveness was defined by the number of seizures per month. Device longevity, procedures, resource and medication use were gathered and validated with a local Key Opinion Leader. Costs were taken from the official 2019 Colombian public price list; medical device prices were provided by Medtronic. Colombian mortality rates, and a 3.5% discount rate for health outcomes and costs, were assumed. Results were presented as cost per quality adjusted life year (QALY). All costs were converted to 2019 US Dollars to allow for international comparison.

RESULTS

Total costs were estimated to be USD$57,410, USD$85,630 and USD$18,646 for DBS, VNS and AED, respectively. In terms of benefits, DBS resulted in 7.76 QALYs, VNS in 7.03 and 5.79 for AED.

As such, DBS is a dominant therapy compared to VNS. In comparison to AED, DBS has an ICER of USD$19,757, resulting in a cost-effective therapy in Colombia considering a threshold of USD$19,953.

The superior device longevity of DBS was the principal driver of the price difference between DBS and VNS. DBS has a longevity of 15 years.

CONCLUSIONS

Our exploratory findings suggest that DBS is a cost-effective treatment strategy for patients with medically partial-onset seizures patients with refractory epilepsy in the Colombian healthcare system compared to AED and dominant in comparison to VNS.