Impact of Vagus Nerve Stimulation (VNS) on Patterns of Use and Cost of Healthcare Services and Pharmacotherapy Among Pediatric Patients with Drug-resistant Epilepsy (DRE)
Abstract number :
3.383
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2023
Submission ID :
1136
Source :
www.aesnet.org
Presentation date :
12/4/2023 12:00:00 AM
Published date :
Authors :
Presenting Author: Reginald Lassagne, MSc – LivaNova
Vanessa Danielson, MSc – LivaNova; Kathryn Evans, MS, MPH – Evidera; Tom Vincent, MPA, MPH – Evidera; Qian Li, PhD – Evidera; Lu Zhang, PhD – Ann and Robert H Lurie Children Hospital; Sandi Lam, MD, MBA – Ann and Robert H Lurie Children Hospital; Ariel Berger, MPH – Evidera
Rationale: VNS is the only neuromodulation device that has been approved by the United States (US) Food and Drug Administration (FDA) for implantation in pediatric patients (aged four years and older) who are refractory to ASM treatment. The aim of this study was to examine the impact of VNS as treatment for DRE on patterns of use and cost of healthcare services and pharmacotherapy among pediatric patients with DRE in the United States (US).
Methods: Using a large US healthcare claims database, we identified all DRE patients who underwent VNS implantation between 2012 and 2019. The earliest date during this period on which evidence of VNS implantation was identified was designated the index date. We excluded patients without an epilepsy diagnosis on their index date, and those: (1) aged ≥18 years on index date; or (2) not continuously enrolled in the database for the two-year period prior to index date (“pre-index”). Pre-index data on use and cost of healthcare services and pharmacotherapy (except care related to pre-operative medical clearance for VNS) was used to estimate multivariate regression models that predicted outcomes during the 24-month post-index period (follow-up). Predicted outcomes during follow-up were then compared with observed values, with resulting differences assumed equivalent to the expected impact of VNS on levels of use and cost of healthcare services and prescription pharmacotherapy.
Results: A total of 254 children underwent VNS for DRE and met all other selection criteria. Observed values for the composite outcome of all-cause hospitalizations and ED visits were 34% lower than expected (visits per 100 person-months [PM]: 20.16 vs. 30.4) over the 24-month follow-up period (p=0.032). For the composite outcome of epilepsy-related hospitalizations and ED visits, it was 46% lower than expected (visits per 100 PM: 15.83 vs. 29.11) (p< 0.001; Figure). Observed mean cumulative total all-cause costs, inclusive of costs of the procedure, did not significantly differ from expected costs by month 15 of follow-up; mean cumulative
Health Services (Delivery of Care, Access to Care, Health Care Models)