title: Long-term reduction of health care costs and utilization after epilepsy surgery.
abstract: OBJECTIVE
  To assess long-term direct medical costs, health care utilization, and mortality following resective surgery in persons with uncontrolled epilepsy.
  
  
  METHODS
  Retrospective longitudinal cohort study of Medicaid beneficiaries with epilepsy from 2000 to 2008. The study population included 7,835 persons with uncontrolled focal epilepsy ages 18-64 years, with an average follow-up time of 5 years. Of these, 135 received surgery during the study period. To account for selection bias, we used risk-set optimal pairwise matching on a time-varying propensity score, and inverse probability of treatment weighting. Repeated measures generalized linear models were used to model utilization and cost outcomes. Cox proportional hazard was used to model survival.
  
  
  RESULTS
  The mean direct medical cost difference between the surgical group and control group was $6,806 after risk-set matching. The incidence rate ratio of inpatient, emergency room, and outpatient utilization was lower among the surgical group in both unadjusted and adjusted analyses. There was no significant difference in mortality after adjustment. Among surgical cases, mean annual costs per subject were on average $6,484 lower, and all utilization measures were lower after surgery compared to before.
  
  
  CONCLUSIONS
  Subjects that underwent epilepsy surgery had lower direct medical care costs and health care utilization. These findings support that epilepsy surgery yields substantial health care cost savings.
authors.affiliation: Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio, U.S.A.|Center for Child Health and Policy, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio, U.S.A.
authors.forename: Nicholas K
authors.identifier: http://orcid.org/0000-0003-0122-6477
authors.initials: NK
authors.lastname: Schiltz
authors.affiliation: Swedish Neuroscience Institute, Epilepsy Center, Seattle, Washington, U.S.A.
authors.forename: Kitti
authors.initials: K
authors.lastname: Kaiboriboon
authors.affiliation: Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio, U.S.A.
authors.forename: Siran M
authors.initials: SM
authors.lastname: Koroukian
authors.affiliation: Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio, U.S.A.
authors.forename: Mendel E
authors.initials: ME
authors.lastname: Singer
authors.affiliation: Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio, U.S.A.|Department of Medicine, CWRU at MetroHealth Medical Center, Cleveland, Ohio, U.S.A.|Center for Health Care Research and Policy, CWRU at MetroHealth Medical Center, Cleveland, Ohio, U.S.A.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Love
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data; D016022:Case-Control Studies; D015331:Cohort Studies; D000069279:Drug Resistant Epilepsy / Q000191:economics / Q000601:surgery*; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D004828:Epilepsies, Partial / Q000191:economics / Q000601:surgery*; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics; D009820:Ohio; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
keywords: Comparative Effectiveness; Economic; Lobectomy; Medicaid; Refractory