Evidence map›Paper›PMID 36927880›Full record

SynthesisNeurology2023

Systematic Review of Cost-Effectiveness Analysis for Surgical and Neurostimulation Treatments for Drug-Resistant Epilepsy in Adults.

Nicholas Ngan Kee, Emma Foster, Clara Marquina, Andy Tan, Samantha S T Pang, Terence J O'Brien, Patrick Kwan, Graeme D Jackson, Zhibin Chen, Zanfina Ademi

Open access · greenAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Neurology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 2 pooled it
2.1field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 17 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 1 institution in 1 country.

Nicholas Ngan KeeFrom the The Royal Melbourne Hospital (N.N.K., T.J.O.B., P.K.), Parkville; Department of Neuroscience (E.F., T.J.O.B., P.K., Z.C., Z.A.), Central Clinical School, Monash University, Melbourne; Department of Neurology (E.F., T.J.O.B., P.K., Z.C.), Alfred Health, Melbourne; School of Public Health and Preventive Medicine (C.M., P.K., Z.C., Z.A.), Monash University, Melbourne; Centre for Medicine Use and Safety (C.M., Z.A.), Monash University, Parkville; Faculty of Medicine, Nursing and Health Sciences (A.T., S.S.T.P.), Monash University, Clayton; Department of Medicine (T.J.O.B., P.K., G.D.J., Z.C.), The University of Melbourne, Parkville; Monash Institute of Medical Engineering (P.K.), Monash University, Clayton; Florey Institute of Neuroscience and Mental Health (G.D.J.), Melbourne; and Department of Neurology (G.D.J.), Austin Hospital, Heidelberg, Australia.
Emma FosterFrom the The Royal Melbourne Hospital (N.N.K., T.J.O.B., P.K.), Parkville; Department of Neuroscience (E.F., T.J.O.B., P.K., Z.C., Z.A.), Central Clinical School, Monash University, Melbourne; Department of Neurology (E.F., T.J.O.B., P.K., Z.C.), Alfred Health, Melbourne; School of Public Health and Preventive Medicine (C.M., P.K., Z.C., Z.A.), Monash University, Melbourne; Centre for Medicine Use and Safety (C.M., Z.A.), Monash University, Parkville; Faculty of Medicine, Nursing and Health Sciences (A.T., S.S.T.P.), Monash University, Clayton; Department of Medicine (T.J.O.B., P.K., G.D.J., Z.C.), The University of Melbourne, Parkville; Monash Institute of Medical Engineering (P.K.), Monash University, Clayton; Florey Institute of Neuroscience and Mental Health (G.D.J.), Melbourne; and Department of Neurology (G.D.J.), Austin Hospital, Heidelberg, Australia.
Clara MarquinaFrom the The Royal Melbourne Hospital (N.N.K., T.J.O.B., P.K.), Parkville; Department of Neuroscience (E.F., T.J.O.B., P.K., Z.C., Z.A.), Central Clinical School, Monash University, Melbourne; Department of Neurology (E.F., T.J.O.B., P.K., Z.C.), Alfred Health, Melbourne; School of Public Health and Preventive Medicine (C.M., P.K., Z.C., Z.A.), Monash University, Melbourne; Centre for Medicine Use and Safety (C.M., Z.A.), Monash University, Parkville; Faculty of Medicine, Nursing and Health Sciences (A.T., S.S.T.P.), Monash University, Clayton; Department of Medicine (T.J.O.B., P.K., G.D.J., Z.C.), The University of Melbourne, Parkville; Monash Institute of Medical Engineering (P.K.), Monash University, Clayton; Florey Institute of Neuroscience and Mental Health (G.D.J.), Melbourne; and Department of Neurology (G.D.J.), Austin Hospital, Heidelberg, Australia.
Andy TanFrom the The Royal Melbourne Hospital (N.N.K., T.J.O.B., P.K.), Parkville; Department of Neuroscience (E.F., T.J.O.B., P.K., Z.C., Z.A.), Central Clinical School, Monash University, Melbourne; Department of Neurology (E.F., T.J.O.B., P.K., Z.C.), Alfred Health, Melbourne; School of Public Health and Preventive Medicine (C.M., P.K., Z.C., Z.A.), Monash University, Melbourne; Centre for Medicine Use and Safety (C.M., Z.A.), Monash University, Parkville; Faculty of Medicine, Nursing and Health Sciences (A.T., S.S.T.P.), Monash University, Clayton; Department of Medicine (T.J.O.B., P.K., G.D.J., Z.C.), The University of Melbourne, Parkville; Monash Institute of Medical Engineering (P.K.), Monash University, Clayton; Florey Institute of Neuroscience and Mental Health (G.D.J.), Melbourne; and Department of Neurology (G.D.J.), Austin Hospital, Heidelberg, Australia.
Samantha S T PangFrom the The Royal Melbourne Hospital (N.N.K., T.J.O.B., P.K.), Parkville; Department of Neuroscience (E.F., T.J.O.B., P.K., Z.C., Z.A.), Central Clinical School, Monash University, Melbourne; Department of Neurology (E.F., T.J.O.B., P.K., Z.C.), Alfred Health, Melbourne; School of Public Health and Preventive Medicine (C.M., P.K., Z.C., Z.A.), Monash University, Melbourne; Centre for Medicine Use and Safety (C.M., Z.A.), Monash University, Parkville; Faculty of Medicine, Nursing and Health Sciences (A.T., S.S.T.P.), Monash University, Clayton; Department of Medicine (T.J.O.B., P.K., G.D.J., Z.C.), The University of Melbourne, Parkville; Monash Institute of Medical Engineering (P.K.), Monash University, Clayton; Florey Institute of Neuroscience and Mental Health (G.D.J.), Melbourne; and Department of Neurology (G.D.J.), Austin Hospital, Heidelberg, Australia.
Terence J O'BrienFrom the The Royal Melbourne Hospital (N.N.K., T.J.O.B., P.K.), Parkville; Department of Neuroscience (E.F., T.J.O.B., P.K., Z.C., Z.A.), Central Clinical School, Monash University, Melbourne; Department of Neurology (E.F., T.J.O.B., P.K., Z.C.), Alfred Health, Melbourne; School of Public Health and Preventive Medicine (C.M., P.K., Z.C., Z.A.), Monash University, Melbourne; Centre for Medicine Use and Safety (C.M., Z.A.), Monash University, Parkville; Faculty of Medicine, Nursing and Health Sciences (A.T., S.S.T.P.), Monash University, Clayton; Department of Medicine (T.J.O.B., P.K., G.D.J., Z.C.), The University of Melbourne, Parkville; Monash Institute of Medical Engineering (P.K.), Monash University, Clayton; Florey Institute of Neuroscience and Mental Health (G.D.J.), Melbourne; and Department of Neurology (G.D.J.), Austin Hospital, Heidelberg, Australia.
Patrick KwanFrom the The Royal Melbourne Hospital (N.N.K., T.J.O.B., P.K.), Parkville; Department of Neuroscience (E.F., T.J.O.B., P.K., Z.C., Z.A.), Central Clinical School, Monash University, Melbourne; Department of Neurology (E.F., T.J.O.B., P.K., Z.C.), Alfred Health, Melbourne; School of Public Health and Preventive Medicine (C.M., P.K., Z.C., Z.A.), Monash University, Melbourne; Centre for Medicine Use and Safety (C.M., Z.A.), Monash University, Parkville; Faculty of Medicine, Nursing and Health Sciences (A.T., S.S.T.P.), Monash University, Clayton; Department of Medicine (T.J.O.B., P.K., G.D.J., Z.C.), The University of Melbourne, Parkville; Monash Institute of Medical Engineering (P.K.), Monash University, Clayton; Florey Institute of Neuroscience and Mental Health (G.D.J.), Melbourne; and Department of Neurology (G.D.J.), Austin Hospital, Heidelberg, Australia.
Graeme D JacksonFrom the The Royal Melbourne Hospital (N.N.K., T.J.O.B., P.K.), Parkville; Department of Neuroscience (E.F., T.J.O.B., P.K., Z.C., Z.A.), Central Clinical School, Monash University, Melbourne; Department of Neurology (E.F., T.J.O.B., P.K., Z.C.), Alfred Health, Melbourne; School of Public Health and Preventive Medicine (C.M., P.K., Z.C., Z.A.), Monash University, Melbourne; Centre for Medicine Use and Safety (C.M., Z.A.), Monash University, Parkville; Faculty of Medicine, Nursing and Health Sciences (A.T., S.S.T.P.), Monash University, Clayton; Department of Medicine (T.J.O.B., P.K., G.D.J., Z.C.), The University of Melbourne, Parkville; Monash Institute of Medical Engineering (P.K.), Monash University, Clayton; Florey Institute of Neuroscience and Mental Health (G.D.J.), Melbourne; and Department of Neurology (G.D.J.), Austin Hospital, Heidelberg, Australia.ORCID 0000-0002-7917-5326
Zhibin ChenFrom the The Royal Melbourne Hospital (N.N.K., T.J.O.B., P.K.), Parkville; Department of Neuroscience (E.F., T.J.O.B., P.K., Z.C., Z.A.), Central Clinical School, Monash University, Melbourne; Department of Neurology (E.F., T.J.O.B., P.K., Z.C.), Alfred Health, Melbourne; School of Public Health and Preventive Medicine (C.M., P.K., Z.C., Z.A.), Monash University, Melbourne; Centre for Medicine Use and Safety (C.M., Z.A.), Monash University, Parkville; Faculty of Medicine, Nursing and Health Sciences (A.T., S.S.T.P.), Monash University, Clayton; Department of Medicine (T.J.O.B., P.K., G.D.J., Z.C.), The University of Melbourne, Parkville; Monash Institute of Medical Engineering (P.K.), Monash University, Clayton; Florey Institute of Neuroscience and Mental Health (G.D.J.), Melbourne; and Department of Neurology (G.D.J.), Austin Hospital, Heidelberg, Australia. ben.chen1@monash.edu zanfina.ademi@monash.edu.ORCID 0000-0002-1888-6917
Zanfina AdemiFrom the The Royal Melbourne Hospital (N.N.K., T.J.O.B., P.K.), Parkville; Department of Neuroscience (E.F., T.J.O.B., P.K., Z.C., Z.A.), Central Clinical School, Monash University, Melbourne; Department of Neurology (E.F., T.J.O.B., P.K., Z.C.), Alfred Health, Melbourne; School of Public Health and Preventive Medicine (C.M., P.K., Z.C., Z.A.), Monash University, Melbourne; Centre for Medicine Use and Safety (C.M., Z.A.), Monash University, Parkville; Faculty of Medicine, Nursing and Health Sciences (A.T., S.S.T.P.), Monash University, Clayton; Department of Medicine (T.J.O.B., P.K., G.D.J., Z.C.), The University of Melbourne, Parkville; Monash Institute of Medical Engineering (P.K.), Monash University, Clayton; Florey Institute of Neuroscience and Mental Health (G.D.J.), Melbourne; and Department of Neurology (G.D.J.), Austin Hospital, Heidelberg, Australia. ben.chen1@monash.edu zanfina.ademi@monash.edu.ORCID 0000-0002-0625-3522
The Royal Melbourne Hospital · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesSurgical and neurostimulator treatments are effective for reducing seizure burden in selected individuals living with drug-resistant epilepsy (DRE). We aimed to determine the presence and key model determinants for cost-effectiveness of these interventions, compared with medical management alone, to assist with decisions about resource allocation.

methodsA systematic literature search was conducted on June 1, 2022, using MEDLINE, EMBASE, the NHS Economic Evaluation Database, and the Cost-Effectiveness Analysis database. Included studies were economic evaluations in adult DRE cohorts, comparing surgical and neurostimulator treatments (vagus nerve stimulation [VNS], responsive neurostimulation [RNS], and deep brain stimulation [DBS]) vs medical management alone and reporting cost-benefit analysis, cost-utility, or cost-effectiveness. Exclusion criteria were studies with pediatric cohorts and those published in a language other than English. Three independent reviewers screened, extracted, and assessed data against the Consolidated Health Economic Evaluation Reporting Standards checklist, and a fourth reviewer adjudicated discrepancies.

resultsTen studies met inclusion criteria. Seven studies evaluated epilepsy surgery, and 3 evaluated neurostimulation treatments. All relevant studies established that epilepsy surgery is a cost-effective intervention compared with medical management alone, for quality-adjusted life-years and seizure freedom at 2 and 5 years. All relevant studies found neurostimulator treatments to be potentially cost-effective. The incremental cost-effectiveness ratio (ICER), with lower ICER indicating greater cost-effectiveness, was reported for 9 studies and varied between GBP £3,013 and US $61,333. Cost adaptation revealed ICERs from US $170 to US $121,726. Key model determinants included, but were not limited to, improved surgical outcomes and quality of life, reduced surgical and presurgical evaluation costs, higher rates of surgical eligibility after referral and evaluation, epilepsy subtype, less expensive neurostimulator devices with improved longevity, and cost analysis strategy used in the analysis. DISCUSSION: There is consistent evidence that epilepsy surgery is a cost-effective treatment of eligible candidates with DRE. Limited evidence suggests that VNS, RNS, and DBS may be cost-effective therapies for DRE, although more health economic evaluations alongside prospective clinical trials are needed to validate these findings. STUDY REGISTRATION INFORMATION: PROSPERO CRD42021278436.

Indexed as

Drug Resistant EpilepsyEpilepsyAdultChildCost-Benefit AnalysisCost-Effectiveness AnalysisHumansProspective StudiesQuality of Life

Identifiers

PMID36927880
PMCPMC10159768
OpenAlexW4327545990

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.