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Vagus nerve stimulation for medically refractory epilepsy: efficacy and cost-benefit analysis

Paul Boon UGent, Kristl Vonck UGent, T Vandekerckhove, M D'Have, L Nieuwenhuis, G Michielsen, H Vanbelleghem, I Goethals, Jacques Caemaert UGent and Luc Calliauw, et al. (1999) ACTA NEUROCHIRURGICA. 141(5). p.447-453
abstract
Introduction. Vagus nerve stimulation is a novel treatment for patients with medically refractory epilepsy, who are not candidates for conventional epilepsy surgery, or who have had such surgery without optimal outcome. To date only studies with relatively short follow-up are available. In these studies efficacy increased with time and reached a maximum after a period of 6 to 12 months. Implantation of a vagus nerve stimulator requires an important financial investment but a cost-benefit analysis has not been published. Patients and Methods. Our own experience with VNS in Gent comprises 15 patients with mean age of 29 years (range: 17-44 years) and mean duration of epilepsy of 18 years (range: 4-32 years). All patients underwent a comprehensive presurgical evaluation and were found not to be suitable candidates for resective epilepsy surgery. Mean post-implantation follow-up is 24 months (range: 7-43 months). In patients with follow-up of at least one year, efficacy of treatment in terms of seizure control and seizure severity was assessed one year before and after the implantation of a vagus nerve stimulator. Epilepsy-related direct medical costs (ERDMC) before and after the implantation were also compared. Results. A mean reduction of seizure frequency from 14 seizures/month (range: 2-40/month) to 8 seizures/month (range: 0-30/month) was achieved (Wilcoxon signed rank test n = 14; p = 0.0016). Five patients showed a marked seizure reduction of greater than or equal to 50%; 6 became free of complex partial seizures, 3 of whom became entirely seizure free for more than 12 months; 2 patients had a worthwhile reduction of seizure frequency between 30-50%; in 2 patients seizure frequency reduction has remained practically unchanged. Seizure freedom or greater than or equal to 50% seizure reduction was achieved within the first 4 months after implantation in 6/11 patients. Before the implantation, the mean yearly epilepsy-related direct medical costs per patient were estimated to be 8830 US$ (n = 13; range: 1879-31129 US$; sd = 7667); the average number of hospital admission days per year was 21 (range: 4-100; sd = 25.7). In the 12 months after implantation, ERDMC had decreased to 4215 US$ (range: 615-11794 US$; sd = 3558) (Wilcoxon signed rank test n = 13; p = 0.018) and the average number of admission days to 8 (range: 0-35) (Wilcoxon signed rank test n = 13; p = 0.023). Conclusion. VNS is an effective treatment of refractory epilepsy and remains effective during long-term follow-up. Cost-benefit analysis suggests that the cost of VNS is saved within two years following implantation.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
refractory epilepsy, vagus nerve stimulation (VNS), EEG, epilepsy surgery, cost-benefit analysis, PARTIAL SEIZURES, CARBAMAZEPINE, THERAPY, SAFETY, TRIAL
journal title
ACTA NEUROCHIRURGICA
Acta Neurochir.
volume
141
issue
5
pages
447 - 453
Web of Science type
Article
Web of Science id
000080490200003
ISSN
0001-6268
DOI
10.1007/s007010050324
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
114109
handle
http://hdl.handle.net/1854/LU-114109
date created
2004-01-14 13:35:00
date last changed
2014-09-26 14:18:18
@article{114109,
  abstract     = {Introduction. Vagus nerve stimulation is a novel treatment for patients with medically refractory epilepsy, who are not candidates for conventional epilepsy surgery, or who have had such surgery without optimal outcome. To date only studies with relatively short follow-up are available. In these studies efficacy increased with time and reached a maximum after a period of 6 to 12 months. Implantation of a vagus nerve stimulator requires an important financial investment but a cost-benefit analysis has not been published. 
Patients and Methods. Our own experience with VNS in Gent comprises 15 patients with mean age of 29 years (range: 17-44 years) and mean duration of epilepsy of 18 years (range: 4-32 years). All patients underwent a comprehensive presurgical evaluation and were found not to be suitable candidates for resective epilepsy surgery. Mean post-implantation follow-up is 24 months (range: 7-43 months). In patients with follow-up of at least one year, efficacy of treatment in terms of seizure control and seizure severity was assessed one year before and after the implantation of a vagus nerve stimulator. Epilepsy-related direct medical costs (ERDMC) before and after the implantation were also compared. 
Results. A mean reduction of seizure frequency from 14 seizures/month (range: 2-40/month) to 8 seizures/month (range: 0-30/month) was achieved (Wilcoxon signed rank test n = 14; p = 0.0016). Five patients showed a marked seizure reduction of greater than or equal to 50\%; 6 became free of complex partial seizures, 3 of whom became entirely seizure free for more than 12 months; 2 patients had a worthwhile reduction of seizure frequency between 30-50\%; in 2 patients seizure frequency reduction has remained practically unchanged. Seizure freedom or greater than or equal to 50\% seizure reduction was achieved within the first 4 months after implantation in 6/11 patients. Before the implantation, the mean yearly epilepsy-related direct medical costs per patient were estimated to be 8830 US\$ (n = 13; range: 1879-31129 US\$; sd = 7667); the average number of hospital admission days per year was 21 (range: 4-100; sd = 25.7). In the 12 months after implantation, ERDMC had decreased to 4215 US\$ (range: 615-11794 US\$; sd = 3558) (Wilcoxon signed rank test n = 13; p = 0.018) and the average number of admission days to 8 (range: 0-35) (Wilcoxon signed rank test n = 13; p = 0.023). 
Conclusion. VNS is an effective treatment of refractory epilepsy and remains effective during long-term follow-up. Cost-benefit analysis suggests that the cost of VNS is saved within two years following implantation.},
  author       = {Boon, Paul and Vonck, Kristl and Vandekerckhove, T and D'Have, M and Nieuwenhuis, L and Michielsen, G and Vanbelleghem, H and Goethals, I and Caemaert, Jacques and Calliauw, Luc and De Reuck, Jacques},
  issn         = {0001-6268},
  journal      = {ACTA NEUROCHIRURGICA},
  keyword      = {refractory epilepsy,vagus nerve stimulation (VNS),EEG,epilepsy surgery,cost-benefit analysis,PARTIAL SEIZURES,CARBAMAZEPINE,THERAPY,SAFETY,TRIAL},
  language     = {eng},
  number       = {5},
  pages        = {447--453},
  title        = {Vagus nerve stimulation for medically refractory epilepsy: efficacy and cost-benefit analysis},
  url          = {http://dx.doi.org/10.1007/s007010050324},
  volume       = {141},
  year         = {1999},
}

Chicago
Boon, Paul, Kristl Vonck, T Vandekerckhove, M D’Have, L Nieuwenhuis, G Michielsen, H Vanbelleghem, et al. 1999. “Vagus Nerve Stimulation for Medically Refractory Epilepsy: Efficacy and Cost-benefit Analysis.” Acta Neurochirurgica 141 (5): 447–453.
APA
Boon, Paul, Vonck, K., Vandekerckhove, T., D’Have, M., Nieuwenhuis, L., Michielsen, G., Vanbelleghem, H., et al. (1999). Vagus nerve stimulation for medically refractory epilepsy: efficacy and cost-benefit analysis. ACTA NEUROCHIRURGICA, 141(5), 447–453.
Vancouver
1.
Boon P, Vonck K, Vandekerckhove T, D’Have M, Nieuwenhuis L, Michielsen G, et al. Vagus nerve stimulation for medically refractory epilepsy: efficacy and cost-benefit analysis. ACTA NEUROCHIRURGICA. 1999;141(5):447–53.
MLA
Boon, Paul, Kristl Vonck, T Vandekerckhove, et al. “Vagus Nerve Stimulation for Medically Refractory Epilepsy: Efficacy and Cost-benefit Analysis.” ACTA NEUROCHIRURGICA 141.5 (1999): 447–453. Print.