Outcomes/Effectiveness Research

Successful epilepsy surgery reduces health care costs

About 20 to 30 percent of epilepsy patients in the United States have continued seizures despite medication (medically intractable epilepsy, MIE). These intractable cases account for 42 percent of the estimated $1.7 billion in epilepsy's annual direct medical costs. Surgery is increasingly being used to treat refractory epilepsy, with the number of surgical epilepsy centers having increased substantially in the last 15 years. Not only is surgery effective for many patients, but a new study found that health care costs decline after successful epilepsy surgery.

John T. Langfitt, Ph.D., of the University of Rochester, and colleagues examined the medical records of 68 patients with temporal lobe epilepsy (TLE) at multiple clinical centers. They examined health care costs for the 2 years prior to and 2 years after surgical evaluation. Antiepileptic drugs (AEDs) accounted for more than half of the costs of care in the pre-evaluation period. Total costs for seizure-free patients had declined 32 percent by 2 years following surgery due to less use of AEDs and inpatient care.

Costs did not change in patients whose seizures persisted, whether they had surgery or not. In the 18 to 24 months after evaluation, epilepsy-related costs were $2,068 to $2,094 in patients with persistent seizures versus $582 in seizure-free patients. Thus, epilepsy surgery that completely controlled seizures resulted in a substantial reduction in health care costs by 2 years after surgery. Further cost reductions in seizure-free patients can be expected as the patient is able to stop taking antiepileptic drugs. The frequency and intensity of outpatient care can also be expected to decline.

If epilepsy surgery is to be cost-effective from a public health perspective, it is important to select patients for surgery evaluation who are most likely to become seizure-free after surgery, conclude the researchers. Their study was support in part by the Agency for Healthcare Research and Quality (HS09986).

More details are in "Health care costs decline after successful epilepsy surgery," by Dr. Langfitt, R.G. Holloway, M.D., M.P. McDermott, Ph.D., and others, in the April 17, 2007, Neurology 68, pp. 1290-1298.

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