Financial Comparison of Laser Interstitial Thermal Therapy versus Anterior Temporal Lobectomy in Patients with Temporal Lobe Epilepsy
Abstract number :
2.31
Submission category :
9. Surgery / 9A. Adult
Year :
2023
Submission ID :
734
Source :
www.aesnet.org
Presentation date :
12/3/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: James Mercer, MD – Medical University of South Carolina
Zeke Campbell, MD – Assistant Professor, Neurology, Medical University of South Carolina
Rationale: Laser interstitial thermal therapy (LITT) and anterior temporal lobectomy (ATL) are both effective treatments for patients with medication-refractory medial temporal lobe epilepsy (MTLE). LITT is less invasive and considered to have less morbidity, particularly when it comes to risk of verbal memory (Bauman et al, 2019), although meta-analyses have shown ATL to be more effective in terms of seizure freedom (Kohlhase et al, 2021). To date, only a single small study (Hines et al, 2022) has examined the financial costs associated with the two procedures, and although LITT was found to be less than ATL, the study did not examine the costs including subsequent intervention, overall seizure freedom, or the costs as a measure of seizure freedom.
Methods: Clinical, radiographic, electrophysiologic, and financial data were reviewed retrospectively for patients older than age eighteen years with MTLE who had undergone an ATL, LITT, or both between January 1, 2016 and December 31, 2022. If patients underwent ATL and or LITT during the specified timeframe and had undergone a previous ATL or LITT, those procedures were included in the analysis, although financial data for the prior procedures was not available. For patients who underwent multiple procedures, the initial procedures were regarded as failures, and the costs of additional procedures were added to those initial procedures.
Results: Eighty-eight patients who underwent a total of 102 surgeries were identified. Sixty-two ATLs and 40 LITTs were performed, with 14 patients undergoing LITT followed by ATL. While the average total cost of ATL was slightly greater compared to LITT only ($86,487.21 compared to $82,176.27), when the costs of subsequent ATL was added to the total costs, the costs for ATL was less than LITT ($86,487.21 compared to $101,090.18), although this total was not statistically significant. However, the difference is seizure freedom of ATL compared to LITT (74.2% versus 27.8%) were statistically different. The outcome and financial data for the procedures are outlined the table 1.
Conclusions: The findings of our study align with prior research, demonstrating a marginal increase in the average cost of ATL compared to LITT as a standalone intervention. When considering the inclusion of subsequent ATL procedures in the total cost of LITT, the average cost escalates further; however, this disparity in cost when including subsequent ATL lacks statistical significance. This may show further evidence that LITT significantly lowers the cost of temporal lobe epilepsy patients. Conducting prospective studies with larger sample sizes, comprehensive cost breakdowns, and long-term seizure freedom outcomes will provide more accurate insights into the costs of these interventions.
Funding: No funding was received in support of this abstract.
Surgery