Costs of Care Following Implantation of Vagus Nerve Stimulation (VNS) vs. Responsive Neurostimulation or Deep Brain Stimulation (RNS/DBS) Among Medicare Enrollees with Drug-Resistant Epilepsy (DRE)
Abstract number :
3.324
Submission category :
9. Surgery / 9C. All Ages
Year :
2023
Submission ID :
1163
Source :
www.aesnet.org
Presentation date :
12/4/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Tom Vincent, MPA, MPH – Evidera
Reginald Lassagne, MSc – LivaNova; Sandi Lam, MD, MBA – Ann and Robert H Lurie Children Hospital; Kathryn Evans, MS, MPH – Evidera; Qian Li, PhD – Evidera; Lu Zhang, PhD – Ann and Robert H Lurie Children Hospital; Vanessa Danielson, MSc – LivaNova; Ariel Berger, MPH – Evidera
Rationale: Persons with epilepsy who do not adequately respond to ≥2 different regimens of anti-seizure medications (ASMs) are considered to have DRE. Neurostimulators (i.e., VNS, RNS, DBS) are an important alternative to additional ASMs in these patients, and have been shown in patients with DRE to control seizures and improve quality of life. We previously found VNS associated with lower levels of hospitalization and emergency department (ED) visits and significantly lower costs of care during the two year period following implantation relative to a propensity-matched cohort with commercial (i.e., private) insurance who received RNS or DBS. However, the degree to which this reflects the experience of Medicare enrollees with DRE who undergo implantation is not known.
Methods: We used Medicare fee-for-service healthcare claims obtained from the US Center for Medicare and Medicaid Services to identify patients with DRE who underwent neurostimulator implantation between 2012 and 2019. The earliest date during this period on which implantation was noted was deemed the index date. Patients without an epilepsy diagnosis on index date were excluded, as were patients without ≥1 ASM claims in the year prior to this date, and patients not continuously enrolled during the two year period prior to implantation. Eligible patients were stratified based on device received on index date (VNS vs. RNS/DBS). VNS patients were matched by propensity scoring to RNS/DBS patients. Use and cost of healthcare resources and pharmacotherapy were ascertained over the 24-month period following index. Outcomes were assessed alternatively using an all-cause and epilepsy-related basis, with the latter defined as all medical care claims with diagnoses of epilepsy and all ASM dispenses.
Results: A total of 3,425 patients met all selection criteria, of whom 3,086 (90.1%) received VNS and 339 (9.9%) received RNS/DBS. A total of 338 VNS patients were propensity matched to an equal number of RNS/DBS patients. One year post-index, mean total healthcare costs were 36% lower among VNS patients than RNS/DBS patients (all-cause: $70,591 vs. $110,276; epilepsy-related: $57,361 vs. $89,370); corresponding values at the 2-year mark were 25% lower (all-cause: $101,875 vs. $136,229) and 29% lower (epilepsy-related: $78,068 vs. $105,587) (p< 0.0001 for all comparisons). VNS patients were significantly less likely than their matched RNS/DBS counterparts to experience all-cause hospitalizations (44.7% vs. 58.0%; p=0.0004) and epilepsy-related hospitalizations (43.2% vs. 50.9%; p=0.0398), respectively.
Surgery