OBJECTIVES

: This study aimed to evaluate the cost-utility of vagus nerve stimulation(VNS) for children with intractable epilepsy in Taiwan.

METHODS

: Incremental cost-effectiveness ratio (ICER) was calculated using the net costs from a program of implantation sufficiently large to benefit at least one person, divided by the net gain in quality adjusted life years. Intractable epilepsy patients younger than 12 years of age were selected since they are more sensitive with VNS. There was no other active comparator under Taiwanese National Health Insurance (NHI). Local clinical research studies showed that, for every four people implanted and stimulated with device that there would be at least one person with a 50% or greater reduction in seizure frequency. The claims data of a random sample of epilepsy patients from the National Health Insurance (NHI) database was used to estimate the treatment cost of epilepsy in Taiwan. Out-of-pocket prices of VNS devices obtained from official website of each hospital were used. Time horizon was assumed 6 years since it is how long the battery life of VNS. Other medical services costs of VNS were also obtained from the hospitals.

RESULTS

: The ICER of VNS versus no active treatment was estimated to be 2,236,471/QALY, about 3-times GDP per capita of Taiwan. Sensitivity analysis results showed that the ICER decreases with greater proportion of patients achieving a ≧50% reduction in seizure frequency (ICER=807,000/QALY), lower price of medical device(ICER=858,000/QALY), or longer battery life (ICER=1,584,000/QALY).

CONCLUSIONS

: Previous study showed the VNS is a safety, tolerable adjunctive therapy. Our result suggested that the ICER of VNS therapy in patients with refractory epilepsy in Taiwan NHI is somewhat high, although the local studies had shown promising effectiveness of the therapy.