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Health Technology Assessment report on the presurgical evaluation and surgical treatment of drug‐resistant epilepsy
Author(s) -
Marras Carlo Efisio,
Canevini Maria Paola,
Colicchio Gabriella,
Guerrini Renzo,
Rubboli Guido,
Scerrati Massimo,
Spreafico Roberto,
Tassi Laura,
LoRusso Giorgio,
Tinuper Paolo
Publication year - 2013
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.12309
Subject(s) - medicine , epilepsy , epilepsy surgery , drug resistant epilepsy , intervention (counseling) , quality of life (healthcare) , intensive care medicine , health care , activity based costing , disease , surgery , psychiatry , nursing , economics , economic growth , business , marketing
Summary Purpose Epilepsy is a neurologic disorder with major social impact. Surgery is a valuable option in patients who are not responding to antiepileptic drugs. The literature reports demonstrate that a proportion ranging from 40 to 100% of patients with epilepsy achieve seizure remission after surgery. A presurgical evaluation (clinical and instrumental) must be performed in all patients with drug‐resistant epilepsy to assess their suitability for surgical intervention. H ealth T echnology A ssessment ( HTA ) represents a modern approach to the analysis of technologies used for health care. HTA could be considered a bridge between science that produces evidence and the decisions that can be taken on the basis of that evidence at different levels of the health care system. The aim of this study is the HTA of epilepsy surgery including clinical, ethical, social, and economic features. Methods The present study includes an analysis of the diagnostic and surgical workup performed at the I talian c enters for the diagnosis and treatment of drug‐resistant epilepsy ( DRE ). The study includes the following issues: (1) social, ethical impact, and costs of the disease; (2) clinical results, efficacy, and safety of surgery; (3) ethics and quality of life after surgery; and (4) economic impact and productivity regained after surgery. The cost of managing a patient with DRE included in the presurgical study was estimated by the bottom‐up microcosting technique that starts from a detailed collection of data on consumption of resources and full costing. The phases analyzed were (1) noninvasive diagnostic workup; (2) neurosurgical intervention; and (3) follow‐up. Key Findings The literature reports indicate epilepsy surgery as an effective treatment both on clinical results and on ethical, social, and quality of life aspects. The workup including the noninvasive presurgical study followed by surgery has a total cost of €20,827. Management of short‐term follow‐up increases the overhead to €22,291 at the first year, and then to €23,571 after 5 years. According to the estimates made in this survey, funding based on diagnosis‐related group ( DRG ) tariff for the noninvasive diagnostic stage involving hospital admission is not remunerative in Italy either at regional or national levels. Effectively the difference between full cost and DRG has a delta of €3,402 and €2,537 respectively. The total cost of the presurgical, surgical, and follow‐up evaluation is not remunerative for €10,554 (national data). Significance Economic surveys in Italy have shown that surgery for DRE is an advantageous treatment from the standpoint of third‐party payers and is cost‐effective for society. DRE presurgical evaluation and surgery are not remunerative either at regional or national levels.