title: Clinical and economic impact of vagus nerve stimulation therapy in patients with drug-resistant epilepsy.
abstract: We evaluated long-term medical and economic benefits of vagus nerve stimulation (VNS) therapy in drug-resistant epilepsy. A pre-post analysis was conducted using multistate Medicaid data (January 1997-June 2009). One thousand six hundred fifty-five patients with one or more neurologist visits with epilepsy diagnoses (ICD-9 345.xx, 780.3, or 780.39), one or more procedures for vagus nerve stimulator implantation, one or more antiepileptic drugs (AEDs), and 6 or more months of continuous Medicaid enrollment pre- and post-VNS were selected. The pre-VNS period was 6 months. The post-VNS period extended from implantation to device removal, death, Medicaid disenrollment, or study end (up to 3 years). Incidence rate ratios (IRRs) and cost differences ($2009) were estimated. Mean age was 29.4 years. Hospitalizations decreased post-VNS compared with pre-VNS (adjusted IRR=0.59, P<0.001). Grand mal status events decreased post-VNS compared with pre-VNS (adjusted IRR=0.79, P<0.001). Average total health care costs were lower post-VNS than pre-VNS ($18,550 vs $19,945 quarterly, P<0.001). VNS is associated with decreased resource utilization and epilepsy-related clinical events and net cost savings after 1.5 years.
authors.affiliation: Emory University School of Medicine, Atlanta, GA 30322, USA. sandra.helmers@emory.edu
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Helmers
authors.forename: Mei Sheng
authors.initials: MS
authors.lastname: Duh
authors.forename: Annie
authors.initials: A
authors.lastname: Guérin
authors.forename: Sujata P
authors.initials: SP
authors.lastname: Sarda
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Samuelson
authors.forename: Mark T
authors.initials: MT
authors.lastname: Bunker
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Olin
authors.forename: Stanley D
authors.initials: SD
authors.lastname: Jackson
authors.forename: Edward
authors.initials: E
authors.lastname: Faught
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D004827:Epilepsy / Q000191:economics* / Q000628:therapy*; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation / Q000191:economics* / Q000379:methods*; D055815:Young Adult