Cost-effectiveness analysis of epilepsy surgery in a controlled cohort of adult patients with intractable partial epilepsy: A 5-year follow-up study.
OBJECTIVE
Despite its well-known effectiveness, the cost-effectiveness of epilepsy surgery has never been demonstrated in France. We compared cost-effectiveness between resective surgery and medical therapy in a controlled cohort of adult patients with partial intractable epilepsy.


METHODS
A prospective cohort of adult patients with surgically remediable and medically intractable partial epilepsy was followed over 5 years in the 15 French centers. Effectiveness was defined as 1 year without a seizure, based on the International League Against Epilepsy (ILAE) classification. Clinical outcomes and direct costs were compared between surgical and medical groups. Long-term direct costs and effectiveness were extrapolated over the patients' lifetimes with a Monte-Carlo simulation using a Markov model, and an incremental cost-effectiveness ratio (ICER) was computed. Indirect costs were also evaluated.


RESULTS
Among the 289 enrolled surgery candidates, 207 were operable-119 in the surgical group and 88 in the medical group-65 were not operable and not analyzed here, 7 were finally not eligible, and 10 were not followed. The proportion of patients completely seizure-free during the last 12 months (ILAE class 1) was 69.0% in the operated group and 12.3% in the medical group during the second year (p < 0.001), and it was respectively 76.8% and 21% during the fifth year (p < 0.001). Direct costs became significantly lower in the surgical group the third year after surgery, as a result of less antiepileptic drug use. The value of the discounted ICER was 10,406 (95% confidence interval [CI] 10,182-10,634) at 2 years and 2,630 (CI 95% 2,549-2,713) at 5 years. Surgery became cost-effective between 9 and 10 years after surgery, and even earlier if indirect costs were taken into account as well.


CONCLUSIONS
Our study suggests that in addition to being safe and effective, resective surgery of epilepsy is cost-effective in the medium term. It should therefore be considered earlier in the development of epilepsy.
Clinical Research and Epidemiology Unit, CHU Montpellier, Montpellier, France. mc-picot@chu-montpellier.fr.|INSERM, Clinical Investigation Center 1411, Montpellier, France. mc-picot@chu-montpellier.fr.
Marie-Christine
MC
Picot
Clinical Research and Epidemiology Unit, CHU Montpellier, Montpellier, France.
Audrey
A
Jaussent
INSERM U 1058, Montpellier, France.|University Montpellier, Montpellier, France.
Dorine
D
Neveu
Department of Neurology, GIN, CHU Grenoble, Grenoble, France.|INSERM U836, UJF, Grenoble Alpes University, Grenoble, France.
Philippe
P
Kahane
Epilepsy Unit, CHU Montpellier, Montpellier, France.
Arielle
A
Crespel
Epilepsy Unit, CHU Montpellier, Montpellier, France.
Philippe
P
Gelisse
Department of Neurology, CHU Strasbourg, Strasbourg, France.
Edouard
E
Hirsch
Lille University Medical Center, CHU Lille, EA 1046, University of Lille2, Lille, France.
Philippe
P
Derambure
Epileptology Unit, Assistance Publique-Hôpitaux de Paris, an UPMC University Paris 06, Paris, France.
Sophie
S
Dupont
Department of Neurosurgery, AP-HP and University Paris Descartes, Paris, France.
Elizabeth
E
Landré
Department of Neurosurgery, AP-HP and University Paris Descartes, Paris, France.
Francine
F
Chassoux
Department of Neurology, University Hospital, and UMR 5549, CNRS, Toulouse, France.
Luc
L
Valton
Clinical Neurophysiology and Epileptology Department, University Hospital of Nancy, Nancy, France.
Jean-Pierre
JP
Vignal
Epilepsy Unit, CHU Bordeaux, Bordeaux, France.
Cécile
C
Marchal
Department of Neurology, AP-HP and University Paris Descartes, Paris, France.
Catherine
C
Lamy
Lille University Medical Center, CHU Lille, EA 1046, University of Lille2, Lille, France.|Department of Neurosurgery, AP-HP and University Paris Descartes, Paris, France.|Department of Neurology, AP-HP and University Paris Descartes, Paris, France.
Franck
F
Semah
Department of Neurology, University Hospital of Rennes, Rennes, France.
Arnaud
A
Biraben
Epilepsy, Sleep and Paediatric Neurophysiology Department (ESEFNP), University Hospitals of Lyon (HCL) and DYCOG Team, Lyon Neuroscience Research Centre (CRNL), INSERM U1028, CNRS UMR 5292, Lyon, France.
Alexis
A
Arzimanoglou
La Teppe Epilepsy Center, Tain l'Hermitage, France.
Jérôme
J
Petit
Department of Neurology, University Hospital of Nice, Nice, France.
Pierre
P
Thomas
Clinical Research and Epidemiology Unit, CHU Montpellier, Montpellier, France.
Valérie
V
Macioce
Clinical Research and Epidemiology Unit, CHU Montpellier, Montpellier, France.|INSERM U 1058, Montpellier, France.|University Montpellier, Montpellier, France.
Pierre
P
Dujols
Department of Functional Neurology and Epileptology and the Institute of Epilepsies, Hospices Civils de Lyon, Lyon, France.|Lyon 1 University; Lyon's Neuroscience Research Center, Lyon, France.|Department of Clinical Neurosciences, CHUV, Lausanne, Switzerland.
Philippe
P
Ryvlin
D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods; D000069279:Drug Resistant Epilepsy; D004828:Epilepsies, Partial / Q000188:drug therapy / Q000191:economics* / Q000601:surgery*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics* / Q000379:methods*; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000927:Anticonvulsants
Direct medical costs; Incremental cost-effectiveness ratio; Indirect costs; Prospective study; Refractory epilepsy