Costs and clinical outcomes of epilepsy surgery in children with drug-resistant epilepsy

Purpose Approximately 20% of children with epilepsy are drug-resistant, incurring considerable costs. Epilepsy surgery has been shown to be an effective intervention in this population. This study provides an initial look at the costs associated with surgical management of children with drug-resistant epilepsy as compared with medical management alone. Procedures In a retrospective cohort study of children with drug-resistant epilepsy referred for possible surgical intervention, we compared direct costs of those treated surgically versus those offered surgery but managed medically instead. We also assessed the difference in seizure frequency between the two groups. Findings There were 94 total patients, 78 (83%) in the surgical group and 16 (17%) in the medical group. The median (25th-75th percentile) cost of the epilepsy surgery hospitalization was $118,400 ($101,900-$143,800). Total median annual follow-up costs, not including the cost of surgical hospitalization, were not significantly different between the two groups at 1- or 2-year follow-up. However, the surgical patients who were seizure-free at 1-year follow-up, and those that remained seizure-free at 2-year follow-up, had significantly lower costs compared with the medical group ($8000 versus $16,200, P = 0.04 and $4300 versus $7600, P = 0.05, respectively). The surgical group had significantly fewer seizures compared with the medical group at 1-year follow-up. Conclusions Although epilepsy surgery is expensive and the overall costs of surgical and medical management are similar in the first 2 years, patients who achieved seizure freedom after surgery had lower costs compared with those treated medically.