title: The added clinical and economic value of diagnostic testing for epilepsy surgery.
abstract: The costs, benefits and risks associated with diagnostic imaging investigations for epilepsy surgery necessitate the identification of an optimal pathway in the pre-surgical workup. In order to assess the added value of additional investigations a full cost-effectiveness evaluation should be conducted, taking into account all of the life-time costs and benefits associated with undertaking additional investigations. This paper considers and applies the appropriate framework against which a full evaluation should be assessed. We conducted a systematic review to evaluate the progression of the literature through this framework, finding that only isolated elements of added value have been appropriately evaluated. The results from applying the full added value framework are also presented, identifying an optimal strategy for pre-surgical evaluation for temporal lobe epilepsy surgery. Our results suggest that additional FDG-PET and invasive EEG investigations after an initially discordant MRI and video-EEG appears cost-effective, and that the value of subsequent invasive-EEGs is closely linked to the maintenance of longer-term benefits after surgery. It is integral to the evaluation of imaging technologies in the work-up for epilepsy surgery that the impact of the use of these technologies on clinical decision-making, and on further treatment decisions, is considered fully when informing cost-effectiveness.
authors.affiliation: Centre for Health Economics, University of York, York, United Kingdom. Electronic address: Sebastian.hinde@york.ac.uk.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Hinde
authors.affiliation: Centre for Health Economics, University of York, York, United Kingdom.
authors.forename: Marta
authors.initials: M
authors.lastname: Soares
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, United Kingdom.
authors.forename: Jane
authors.initials: J
authors.lastname: Burch
authors.affiliation: Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Anthony
authors.initials: A
authors.lastname: Marson
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, United Kingdom.
authors.forename: Nerys
authors.initials: N
authors.lastname: Woolacott
authors.affiliation: Centre for Health Economics, University of York, York, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Palmer
mesh_terms: D003362:Cost-Benefit Analysis; D004569:Electroencephalography; D004827:Epilepsy / Q000191:economics / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D059906:Neuroimaging / Q000191:economics*; D011300:Preoperative Care / Q000191:economics*
keywords: Added value; Cost-effectiveness; Epilepsy; Neuroimaging; Seizure; Temporal lobe epilepsy