title: Economics of epilepsy surgery.
abstract: OBJECTIVE
  Surgical decision-making is a complex process. First, a medical decision is made to determine if surgery is necessary. Second, another medical decision is made to determine the type of surgery. Third, a corporate decision is made if such a surgery is financially feasible. Finally, a legal decision is made to proceed or refuse the chosen surgery. This paper examines these issues in the case of surgery for medically intractable epilepsy and proposes a method of decision analysis to guide epilepsy surgery.
  
  
  METHODS
  A stochastic game of imperfect information using techniques of game theory and decision analysis is introduced as an analytical tool for surgical decision-making.
  
  
  RESULTS
  Surgery for appropriately chosen patients suffering from medically intractable epilepsy may not only be feasible, but may be the best medical option and the best financial option for the patient, families, society and the healthcare system. Such a situation would then make it legally or ethically difficult to reject or postpone surgery for these patients.
  
  
  CONCLUSIONS
  A process to collect data to quantify the parameters used in the decision analysis is hereby proposed.
authors.affiliation: Department of Neurosurgery, Loma Linda University Health System, Loma Linda, California, USA, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, Karnataka, India.
authors.forename: Venkatraman
authors.initials: V
authors.lastname: Sadanand
keywords: Decision-analysis; economics; epilepsy; game theory; surgery