Responsive neurostimulation for drug-resistant focal onset epilepsy may be cost effective in the USA

Abstract

According to researchers from the USA, responsive neurostimulation (RNS) therapy for medically-refractory epilepsy very likely falls within the range of cost-effectiveness, depending on method of utility estimation, variability in model inputs, and willingness-to-pay threshold . They used 9-year seizure frequency data from a long-term RNS follow-up study to construct a semi-Markov model that evaluated changes in quality of life and estimated the impact of RNS therapy plus pharmacotherapy versus pharmacotherapy alone on the annual costs of epilepsy care. A public healthcare payer perspective was taken, and costs included those relating to RNS therapy (implantation and re-implantation, programming, and adverse events), medications and epilepsy-related adverse events, with values taken from Medicare 2019 Fee Schedules and other sources. Quality-adjusted life-year (QALY) values were estimated from previous research, using three utility instruments: Time Trade-Off, visual analog scale, and the EuroQol five-dimension scale. Using three different calculated utility value estimates, the incremental cost-effectiveness ratio (ICER) for RNS therapy compared with pharmacotherapy alone were from $US28 825 to $46 596. ICERs were often below $50 000 per QALY and consistently below $100 000 per QALY in multiple sensitivity analyses. Epilepsy care costs associated with seizure frequency had the largest influence on the final ICER in our model; further increases in battery life would significantly reduce the ICER , note the authors.