A cost-effectiveness analysis of anterior temporal lobectomy for intractable temporal lobe epilepsy

被引:67
作者
King, JT
Sperling, MR
Justice, AC
OConnor, MJ
机构
[1] DEPT VET AFFAIRS MED CTR, NEUROSURG SECT, CLEVELAND, OH USA
[2] CASE WESTERN RESERVE UNIV, DEPT NEUROSURG, CLEVELAND, OH 44106 USA
[3] CASE WESTERN RESERVE UNIV, PROGRAM HLTH CARE RES, CLEVELAND, OH 44106 USA
[4] CASE WESTERN RESERVE UNIV, DIV GEN INTERNAL MED, CLEVELAND, OH 44106 USA
[5] UNIV PENN, GRAD HOSP, COMPREHENS EPILEPSY CTR, PHILADELPHIA, PA 19104 USA
[6] UNIV PENN, GRAD HOSP, DEPT NEUROL, PHILADELPHIA, PA 19104 USA
[7] UNIV PENN, GRAD HOSP, DEPT NEUROSURG, PHILADELPHIA, PA 19104 USA
[8] UNIV PENN, MED CTR, DIV NEUROSURG, PHILADELPHIA, PA 19104 USA
关键词
epilepsy; temporal lobe epilepsy; cost-effectiveness analysis; decision analysis; Markov process; surgery;
D O I
10.3171/jns.1997.87.1.0020
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Patients with medically intractable temporal lobe epilepsy are potential candidates for anterior temporal lobectomy (ATL). in which epileptogenic temporal robe tissue is localized and surgically removed. This surgical approach can eliminate or drastically reduce seizures in the majority of patients. The authors used a. decision-analysis model to examine the cost-effectiveness of a surgical evaluation and treatment protocol for medically intractable temporal lobe epilepsy. This model compared a cohort treated with the new protocol with a continuation of their immediate preoperative medical management and projected these differences over the patient's lifetime. The Markov model incorporated postoperative seizure status, patient quality of life, death from surgical and natural causes. discounting, and the direct medical costs associated with outpatient evaluation, hospitalization. surgery, antiepileptic drugs. and lifetime outpatient treatment. The intent-to-treat analysis included patients who underwent evaluation but were not eligible for ATL. Sensitivity analyses were also performed on the variables in the model. Data from the baseline model indicated that evaluation for ATL provided an average of 1.1 additional quality-adjusted life years (QALYs) compared with continued medical management. at an additional cost of $29,800. Combining the clinical and economic outcomes yielded a cost-effectiveness ratio of $27,200 per QALY. This value is comparable to other accepted medical or surgical interventions, such as total knee arthroplasty ($16,780/QALY) or coronary artery balloon angioplasty ($40,800/QALY). Sensitivity analyses demonstrate that the results are critically dependent on postoperative seizure status and improvement in quality of life. Although further work is necessary to quantify the improvement in quality of life after epilepsy surgery better, the present data. indicate that ATL for treatment of intractable temporal robe epilepsy is a cost-effective use of medical resources.
引用
收藏
页码:20 / 28
页数:9
相关论文
共 76 条
[1]  
ANNEGERS JF, 1992, EPILEPSY RES, P231
[2]  
[Anonymous], 1988, CLIN CHEM
[3]   OCCUPATIONAL ADJUSTMENT FOLLOWING NEUROSURGICAL TREATMENT OF EPILEPSY [J].
AUGUSTINE, EA ;
NOVELLY, RA ;
MATTSON, RH ;
GLASER, GH ;
WILLIAMSON, PD ;
SPENCER, DD ;
SPENCER, SS .
ANNALS OF NEUROLOGY, 1984, 15 (01) :68-72
[4]   THE MARKOV PROCESS IN MEDICAL PROGNOSIS [J].
BECK, JR ;
PAUKER, SG .
MEDICAL DECISION MAKING, 1983, 3 (04) :419-458
[5]   PSYCHOSOCIAL DIFFICULTIES AND OUTCOME AFTER TEMPORAL LOBECTOMY [J].
BLADIN, PF .
EPILEPSIA, 1992, 33 (05) :898-907
[6]   EFFECTIVENESS OF TEMPORAL LOBECTOMY MEASURED BY YEARLY FOLLOW-UP AND MULTIVARIATE-ANALYSIS [J].
BLUME, WT ;
DESAI, HB ;
GIRVIN, JP ;
MCLACHLAN, RS ;
LEMIEUX, JF .
JOURNAL OF EPILEPSY, 1994, 7 (03) :203-214
[7]   A cost-effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip [J].
Chang, RW ;
Pellissier, JM ;
Hazen, GB .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1996, 275 (11) :858-865
[8]   A QUANTITATIVE APPROACH TO MEASURING THE SOCIAL EFFECTS OF EPILEPSY [J].
CHAPLIN, JE ;
YEPEZ, R ;
SHORVON, S ;
FLOYD, M .
NEUROEPIDEMIOLOGY, 1990, 9 (03) :151-158
[9]   VALUING THE FUTURE - TEMPORAL DISCOUNTING OF HEALTH AND MONEY [J].
CHAPMAN, GB ;
ELSTEIN, AS .
MEDICAL DECISION MAKING, 1995, 15 (04) :373-386
[10]   TEMPORAL LOBECTOMY FOR INTRACTABLE EPILEPSY - EXPERIENCE WITH 58 CASES OVER 21 YEARS [J].
DAVIES, KG ;
WEEKS, RD .
BRITISH JOURNAL OF NEUROSURGERY, 1993, 7 (01) :23-33