OBJECTIVES : The efficacy of vagus nerve stimulation (VNS) has proven to be comparable to that of anti-epileptic drugs (AEDs) for treating drug-resistant epilepsy (DRE). We aimed to compare epilepsy-related hospitalization costs between pediatric patients treated with AEDs and VNS.

METHODS : Patients aged 0-17 years who were diagnosed with DRE between 1st January 2011 and 31st December 2016 were identified from the Pediatric Health Information System. Patients who underwent surgery or had a history of VNS implanted prior to the study period were excluded. Patients were followed from one year before to two years after the diagnosis date of DRE. The difference-in-difference approach was used to compare the changes in annual total hospitalization cost overtime between patients treated with AEDs and VNS. Generalized linear model with a gamma distribution and a log link was used to adjust for patient characteristics.

RESULTS : The study included 1521 patients treated with VNS and 4541 patients treated with AEDs. The unadjusted average annual total hospitalization costs (in 2018 dollars) for VNS and AEDs during the one year before DRE diagnosis date were $19,999 (outpatient $1,648, inpatient $17,857 and ED $494) and $18,479 (outpatient $1,487, inpatient $16,435 and ED $557), whereas overall, during the two years after DRE diagnosis date, the unadjusted average annual total hospitalization costs for VNS and AEDs were $34,745 (outpatient $14,025, inpatient $20,369 and ED $351) and $40,871 (outpatient $2,136, inpatient $38,248 and ED $487). After covariate adjustment, patients treated with VNS experienced an average adjusted total hospitalization cost savings of $2,140 per patient per year (P<0.0001) relative to the patients treated with AEDs.

CONCLUSIONS : VNS can be a cost-beneficial treatment for DRE compared to AEDs in appropriately selected pediatric patients.