OBJECTIVES

: The aim of our study was to determine the potential savings in anti-epileptic drug (AED) cost in a population of patients with MRI negative refractory epilepsy, going through invasive EEG (iEEG) monitoring and a subsequent epilepsy surgery compared to medical management. If a sustained period of seizure freedom (at least one year) is achieved, the discontinuation of AEDs can be considered, resulting in reduction of long-term drug expenses. Perspective of the analysis was of the third-party payer.

METHODS

: A combination of a short-term decision tree and long-term prevalence Markov process model over a 30-year time horizon in overall were constructed. The drug consumption sub-part of our model was populated with data acquired from the analysis of 53 epilepsy patients who underwent invasive EEG monitoring and subsequent resective epilepsy surgery. Changes in drug consumption were modelled based on the postoperative seizure outcomes of patients (Engel I/A and other Engel classes).

RESULTS

: Based on our model the iEEG intervention in this patient population is cost-effective (ICER=€4,150/QALY; EUR/HUF=320). The high initial cost of the intervention is balanced by the 3.98 QALY gain, and partially by the long-term savings resulted from the reduction in drug consumption during the follow-up period. The average monthly drug expenditure of patient with disabling seizure before the intervention was €80, that dropped in average to €25 and €65 in patients with Engel I/A and other Engel classes respectively. During the 30-year time horizon it resulted a €5,260 cumulated and discounted cost reduction.

CONCLUSIONS

: Based on our results the introduction of iEEG monitoring into the preoperative diagnostic procedure for patients with MR negative refractory epilepsy shows significant follow-up savings which at least partially compensate its high initial cost.