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From the Departments of Neurology (J.T.L., R.G.H., K.S.) and Biostatistics and Computational Biology (M.P.M., S.M.), University of Rochester, Rochester, NY; Department of Biology (A.T.B.), Northern Illinois University, DeKalb, IL; Department of Neurology (S.S.S.), Yale University, New Haven, CT; Department of Neurology (B.G.V.), University of California Los Angeles, Los Angeles, CA; Department of Neurology (M.R.S.), Thomas Jefferson University, Philadelphia, PA; Department of Neurology (C.W.B.), Columbia University, New York, NY; Department of Neurology (S.S.), Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
Address correspondence and reprint requests to Dr. John T. Langfitt, Department of Neurology, University of Rochester, 601 Elmwood Avenue, Box 673, Rochester, NY 14642; e-mail: john_langfitt{at}urmc.rochester.edu
Background: Surgery is an effective, high-cost procedure used increasingly to treat refractory epilepsy. For surgery to be cost-effective, long-term cost savings from reduced health care use should provide some offset to the initial costs of evaluation and surgery. There is little information about how health care costs are affected by evaluation and surgery.
Objective: To determine whether health care costs change when seizures become controlled after surgery.
Methods: Health care costs for the 2 years prior to surgical evaluation and for 2 years afterward were calculated from medical records of 68 subjects with temporal lobe epilepsy (TLE) participating in a multicenter observational study. Costs were compared among patients who did not have surgery, patients who had persisting seizures after surgery, and patients who were seizure free after surgery.
Results: Antiepileptic drugs (AEDs) accounted for more than half of the costs of care in the pre-evaluation period. Total costs for seizure-free patients had declined 32% by 2 years following surgery due to less use of AEDs and inpatient care. Costs did not change in patients with persisting seizures, whether they had surgery or not. In the 18 to 24 months following evaluation, epilepsy-related costs were $2,068 to $2,094 in patients with persisting seizures vs $582 in seizure-free patients.
Conclusions: Costs remain stable over 2 years post-evaluation in patients with temporal lobe epilepsy whose seizures persist, but patients who become seizure free after surgery use substantially less health care than before surgery. Further cost reductions in seizure-free patients can be expected as antiepileptic drugs are successfully eliminated.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the April 17 issue to find the title link for this article.
Supported by RO1 HS09986 (Agency for Healthcare Research and Quality) and RO1 NS32375 (National Institute of Neurological Disorders and Stroke).
Disclosure: The authors report no conflicts of interest.
Results were previously presented at the Annual Meeting of the American Epilepsy Society, Washington, DC, December 2005.
Received March 22, 2006. Accepted in final form December 13, 2006.
Related Article
Neurology 2007 68: 1243-1244.
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  P. M. Phal, A. Usmanov, G. M. Nesbit, J. C. Anderson, D. Spencer, P. Wang, J. A. Helwig, C. Roberts, and B. E. Hamilton Qualitative Comparison of 3-T and 1.5-T MRI in the Evaluation of Epilepsy Am. J. Roentgenol., September 1, 2008; 191(3): 890 - 895. [Abstract] [Full Text] [PDF]
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