One‐year cost‐effectiveness of callosotomy vs vagus nerve stimulation for drug‐resistant seizures in Lennox‐Gastaut Syndrome: A decision analytic model

Abstract

Abstract Objective Palliative epilepsy surgery via corpus callosotomy (CC) or vagus nerve stimulation (VNS) is commonly employed for drug‐resistant seizures in Lennox‐Gastaut Syndrome (LGS). VNS is less effective at reducing seizures but has fewer adverse events, CC is more effective for seizure control, particularly atonic seizures, but can be associated with serious adverse events, and yet their relative cost‐effectiveness remains unknown. Methods To determine which option is most cost‐effective, a decision analytic model was developed to evaluate the risks and benefits of CC and VNS at 1 year based on costs in the United States. Our primary outcome measure was positive seizure outcomes, defined as >50% seizure reduction without procedural complications. Results CC had a 15% greater likelihood of a positive seizure outcome, but per patient costs were $68 147 more than VNS, or $451 952 per positive seizure outcome gained. One‐way sensitivity analyses demonstrate that probabilities of seizure freedom or reduction by VNS or CC and CC cost were most influential on results. When considering atonic seizures, CC had a 27% greater positive outcome likelihood than VNS, the same incremental cost, and cost $250 556 per positive seizure outcome gained. Significance This exploratory model suggests that VNS is more cost‐effective relative to CC at 1 year.

Keywords

• corpus callosotomy
• drug‐resistant epilepsy
• epilepsy surgery
• Lennox‐Gastaut Syndrome
• vagus nerve stimulator