Hospitalization costs and mortality in pediatric patients with drug-resistant epilepsy: vagus nerve stimulation therapy versus medical management
Abstract number :
1012
Submission category :
9. Surgery / 9B. Pediatrics
Year :
2020
Submission ID :
2423345
Source :
www.aesnet.org
Presentation date :
12/7/2020 1:26:24 PM
Published date :
Nov 21, 2020, 02:24 AM
Authors :
Sandi Lam, Ann and Robert H Lurie Children's Hospital of Chicago; Lu Zhang - Ann and Robert H Lurie Children's Hospital; I-Wen Pan - MD Anderson Cancer Center;;
Rationale:
: The efficacy of vagus nerve stimulation (VNS) has proven to be comparable to that of anti‐epileptic drugs (AEDs) for treating drug-resistant epilepsy (DRE). We aimed to compare epilepsy-related hospitalization costs and mortality between pediatric patients treated with AEDs and VNS.
Method:
Patients aged 0-17 years who met criteria for established algorithms identifying DRE between 1st January 2011 and 31st December 2016 were identified from the Pediatric Health Information System; follow up data were available until December 2018. Patients who underwent surgery or had a history of VNS implanted prior to the study period were excluded. Patients were followed with continuous records from one year before the date to up to five years after the date of meeting criteria for DRE. The difference-in-difference approach was used to compare the changes in annual total hospitalization cost overtime between patients treated with AEDs and VNS. Generalized linear model with a gamma distribution and a log link was used to adjust for patient characteristics.
Results:
The study included 1521 patients treated with VNS and 4541 patients treated with AEDs. The unadjusted average annual total hospitalization costs (in 2018 dollars) for VNS and AEDs during the one year before DRE diagnosis date were $19,999 (outpatient $1,648, inpatient $17,857 and ED $494) and $18,479 (outpatient $1,487, inpatient $16,435 and ED $557), whereas overall, during the two years after meeting criteria for DRE, the unadjusted average annual total hospitalization costs for VNS and AEDs were $34,745 (outpatient $14,025, inpatient $20,369 and ED $351) and $40,871 (outpatient $2,136, inpatient $38,248 and ED $487). After covariate adjustment, patients treated with VNS experienced an average adjusted total hospitalization cost savings of $2,140 per patient per year (P< 0.0001) relative to the patients treated with AEDs. 1.3% (20/1521) of patients treated withVNS compared to 3% (139/4541) of patients treated with medications died by December 31, 2018. The difference in the estimate of survival rate beyond 5 years between the two groups is statistically significant. The survival rates for the VNS group and medication group are 98.24% and 96.54%, respectively. The average follow-up time in months for patients treated with VNS and medications is 51.09 months (SD=18.32) and 54.83 months (SD = 20.25), respectively.
Surgery