Drug Resistant Epilepsy (DRE) is associated with poor health outcomes and high healthcare resource utilization. VNS Therapy™ is indicated for use in people with DRE and has been shown to reduce seizure frequency and may improve quality of life. Comparing the admissions and emergency department (ED) visits, and associated healthcare costs, (vs projected costs) (all-cause & epilepsy-related) can help to inform appropriate use of VNS Therapy across commercial insurance (COM), Medicare (MCARE), and Medicaid (MCAID) programs.
We used data from the Merative Marketscan and US Centers for Medicare and Medicaid Services (CMS) to identify COM, MCARE, MCAID enrollees with DRE who underwent VNS implantation. The earliest date on which implantation was noted was designated the index date. We excluded people: (1) without an epilepsy diagnosis on index date; (2) without ASM claims in the year before implantation; and (3) with < 2 years continuous enrollment immediately before indexing. Use of healthcare resources and pharmacotherapy during the 2-year pre-index period, excluding that deemed related to preparing for implantation, was used to develop regression models that estimated expected values over the 24-month post-index period ("follow-up"). Observed outcomes during follow-up were compared to those expected and were assessed alternatively using an all-cause and epilepsy-related basis.
A total of 6,121 people (COM N=659; MCARE N=3,115; MCAID N=2,347) with DRE met all study selection criteria. VNS implantation reduced overall DRE burden, including all-cause and epilepsy-related healthcare use and costs. Mean healthcare costs were lower than expected for all 23 months post-implantation, except for the index month. Observed and expected total costs of care were comparable by Month 17 to 20, suggesting cost-neutrality within 1.5 to 2 years. Results from the MCARE cohort and MCAID cohort population aligned with the results observed in the COM population, showing similar reductions in hospitalizations, ED visits, and lower healthcare costs following VNS implantation; consistency across insurance types increases real-world evidence of VNS benefits.
VNS Therapy Implantation reduces the overall burden of DRE to COM, MCARE, and MCAID insured cohorts, primarily through reductions in hospitalization. The cost of VNS therapy is offset by savings in other healthcare resources within 2 years.