Bryant J, Stein K, Milne R; International Society of Technology Assessment in Health Care. Meeting.

Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 1999; 15: 97.

The National Coordinating Centre for Health Technology Assessment, Wessex Institute for Health Research and Development, University of Southampton, SO16 7PX, UK.

OBJECTIVE: To evaluate the cost-effectiveness of vagus nerve stimulation as adjunctive therapy for partial epilepsy. METHODS: A critical literature review on the effects of treatment, based on a search of MEDLINE, EMBASE, and the Cochrane library. Grey literature and the manufacturer of the implant were consulted. Costs were calculated and cost effectiveness calculated in terms of cost per seizure prevented. A regional expert committee made a recommendation to commissioners and providers on the basis of the evidence. RESULTS: Evidence for the use of VNS comes from two good quality randomized, controlled studies (RCTs), which compare high (therapeutic) stimulation and low (sub-therapeutic) stimulation. These suggest that after VNS a 30% reduction in seizure rate can be expected and that 30% patients may have >=50% reduction in seizure rate. Modelling the possible effects of treatment on a theoretical cohort of 100 patients, we calculated that 86 seizures could be prevented per person per year, assuming 0.79 seizures/day and a 30% reduction in seizure rate. If 30% patients respond to treatment 2580 seizures could be prevented for every 100 patients treated; if 50% patients respond then 4300 seizures could be prevented for every 100 patients treated. Cost of VNS is estimated at about Pounds 10,575. Cost per seizure prevented could range from Pounds 246 to Pounds 410. CONCLUSION: Although the reduction in seizure frequency could represent an important benefit, outcome measures are impossible to interpret in terms of quality of life. There was insufficient evidence to make a judgement on cost-effectiveness. Further research is needed of VNS, particularly to identify patients groups most likely to benefit.

Publication Types:

• Meeting Abstracts

Keywords:

• Combined Modality Therapy
• Cost-Benefit Analysis
• Electric Stimulation Therapy
• Epilepsies, Partial
• Epilepsy
• Humans
• Outcome Assessment (Health Care)
• Prostheses and Implants
• Seizures
• United States
• Vagus Nerve
• economics
• methods
• therapy
• hsrmtgs

Other ID:

• HTX/20602285

UI: 102193974

From Meeting Abstracts