title: Vagus nerve stimulation therapy in a developing country: a long term follow up study and cost utility analysis.
abstract: OBJECTIVE
  To evaluate clinical outcomes, quality-adjusted life years (QALY), cost effectiveness and cost utility associated with VNS therapy in children with refractory epilepsy in a developing country.
  
  
  METHODS
  Retrospective review of all children who underwent VNS implantation at King Abdullah University Hospital and Jordan University Hospital in Jordan.
  
  
  RESULTS
  Twenty eight patients (16 males) had implantation of the VNS therapy system between the years 2007 and 2011. Mean age at implantation was 9.4 years. Mean duration of epilepsy prior to implantation was 6.5 years. The most common seizure type was generalized tonic clonic seizures. Fifteen patients showed a 50% or more reduction in seizure frequency. There was a significant reduction in total number of seizures (p=0.002) and emergency room (ER) visits (p=0.042) after VNS therapy. Atonic seizures were more likely to respond than generalized tonic clonic seizures, p=0.034. Direct hospital costs prior to VNS implantation were analyzed in relation to ER visits and intensive care unit (ICU) admissions. Cost savings per patient did reduce the financial burden of the device by about 30%. There was a QALY gain per lifetime of 3.78 years for children and 1 year for adolescents.
  
  
  CONCLUSIONS
  Response to VNS implantation in Jordan was favorable and similar to what has been previously reported. QALY gain and cost per QALY analysis were encouraging. Cost savings were related to reduction in seizure severity. In circumstances of limited resources as in developing countries, targeting patients with frequent utilization of health services would improve cost effectiveness.
authors.affiliation: Faculty of Medicine, Jordan University of Science and Technology, P O Box 3030, Irbid 22110, Jordan; Faculty of Medicine, University of Jordan, PO Box 1612, Amman 11941, Jordan. Electronic address: Samahk72@yahoo.com.
authors.forename: Samah K
authors.initials: SK
authors.lastname: Aburahma
authors.affiliation: Faculty of Medicine, Jordan University of Science and Technology, P O Box 3030, Irbid 22110, Jordan; Faculty of Medicine, University of Jordan, PO Box 1612, Amman 11941, Jordan. Electronic address: firas@just.edu.jo.
authors.forename: Firas Q
authors.initials: FQ
authors.lastname: Alzoubi
authors.affiliation: Department of Mathematics and Statistics, Jordan University of Science and Technology, P O Box 3030, Irbid 22110, Jordan; Faculty of Medicine, University of Jordan, PO Box 1612, Amman 11941, Jordan. Electronic address: hmhammouri@just.edu.jo.
authors.forename: Hanan M
authors.initials: HM
authors.lastname: Hammouri
authors.affiliation: Faculty of Medicine, University of Jordan, PO Box 1612, Amman 11941, Jordan. Electronic address: masriamira69@hotmail.com.
authors.forename: Amira
authors.initials: A
authors.lastname: Masri
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics*; D004827:Epilepsy / Q000191:economics* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007597:Jordan; D008297:Male; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D016896:Treatment Outcome; D055536:Vagus Nerve Stimulation / Q000009:adverse effects / Q000191:economics*; D055815:Young Adult
keywords: Children; Cost utility; Developing country; Epilepsy; Refractory seizures; Vagus nerve stimulation