Healthcare system costs associated with surgery and medical therapy for children with drug-resistant epilepsy in Ontario

Objective — Improvement in seizure control following epilepsy surgery could lead to lower healthcare resource use and costs, but it is uncertain if this could offset the high costs related to surgery. This study aimed to evaluate phase-specific and cumulative long-term healthcare costs of surgery compared to medical therapy in children with drug-resistant epilepsy from healthcare payer perspective.

Methods — Children who were evaluated for epilepsy surgery and treated with surgery or medical therapy from 2003 to 2018 at the Hospital for Sick Children in Toronto were identified from chart review, and linked to their health administrative databases in Ontario, Canada. Inverse probability of treatment weighting with stabilized weights was used to balance the baseline covariates between the two groups. Patients were assigned to pre-surgery, surgery, short-term (first 2 years), intermediate-term (2-5 years), and long-term (greater than 5 years) post-surgery care-phases, based on treatment trajectory. Phase-specific and cumulative long-term healthcare costs were evaluated. Costs were converted from Canadian to US dollars year 2018 value.

Results — There were 372 surgical and 258 medical patients. Costs were higher in surgical than medical patients for pre-surgery (3 weeks and 39 weeks), surgery and short-term care-phase, and the attributable costs of surgery per 7 patient-day were $1,602 (95%CI: $1,438, $1,785), $172 (95%CI: $147, $185), $19,819 (95%CI: $18,822, $20,932) and $28 (95%CI: $22, $32) respectively. Costs were lower in surgical patients for intermediate- and long-term care-phase, and the attributable costs were -$72 (95%CI: -$124, -$35) and -$94 (95%CI: -$129, -$63) respectively. In surgical patients, costs were highest for surgery followed by pre-surgery care-phase, with hospitalizations accounting for highest cost component. In medical patients, costs increased gradually from pre-surgery to long-term care-phase. Cumulative costs were higher for surgical than medical patients in the first seven years after surgery, but from eight years onwards, costs were lower for surgical patients.

Conclusion — This study demonstrated the long-term economic benefits of epilepsy surgery compared to medical therapy for the healthcare system based on real-world data, which would justify the high costs of surgery. The results will support future economic evaluation comparing minimally invasive treatment such as laser therapy to surgery.