RESULTS: A total of 860 patients met all selection criteria. Comorbidities were common, including anxiety (29.8%), depression (26.7%), and learning disabilities (25.3%). Fifty-nine percent of patients had ≥1 all-cause hospitalizations; 56.7% had ≥1 epilepsy-related admissions. Patients averaged 8.6 epilepsy-related physicians’ office visits, including 5.1 neurologist visits. Mean all-cause and epilepsy-related healthcare costs during pre-implantation were $123,500 and $91,995, respectively; corresponding median values were $74,567 and $53,029. Median monthly all-cause healthcare costs increased by 138.1% (from $1,042 [month 24] to $2,481 in the month prior to implantation); median epilepsy-related costs, by 289.9% (from $383 to $1,492).

CONCLUSIONS: The 2-year period before implantation is a long and expensive journey, during which many DRE patients have encounters resulting in diagnoses of mental health disorders such as depression and anxiety. We likely underestimated patient burden as seizure frequency and severity—and corresponding impacts on quality of life—were unavailable. Further research is needed to understand the clinical, economic, and psychological benefits associated with reducing time between DRE onset and implantation among qualifying patients.