The Effectiveness of Medical and Surgical Treatment for Children With Refractory Epilepsy.
Drug-resistant epilepsy
Effectiveness
Epilepsy surgery
Healthcare utilization
Pediatric epilepsy
Refractory epilepsy
Journal
Neurosurgery
ISSN: 1524-4040
Titre abrégé: Neurosurgery
Pays: United States
ID NLM: 7802914
Informations de publication
Date de publication:
15 12 2020
15 12 2020
Historique:
received:
03
09
2019
accepted:
02
05
2020
pubmed:
28
7
2020
medline:
2
4
2021
entrez:
26
7
2020
Statut:
ppublish
Résumé
Pediatric refractory epilepsy affects quality of life, clinical disability, and healthcare costs for patients and families. To show the impact of surgical treatment for pediatric epilepsy on healthcare utilization compared to medically treated pediatric epilepsy over 5 yr. The Pediatric Health Information System database was used to conduct a cohort study using 5 published algorithms. Refractory epilepsy patients treated with antiepileptic medications (AEDs) only or AEDs plus epilepsy surgery between 1/1/2008 and 12/31/2014 were included. Healthcare utilization following the index date at 2 and 5 yr including inpatient, emergency department (ED), and all epilepsy-related visits were evaluated. The propensity scores (PS) method was used to match surgically and medically treated patients. PS. SAS® 9.4 and Stata 14.0 were used for data management and statistical analysis. A total of 2106 (17.1%) and 10186 (82.9%) were surgically and medically treated. A total of 4050 matched cases, 2025 per each treated group, were included. Compared to medically treated patients, utilization was reduced in the surgical group: at 2 and 5 yr postindex date, there was a reduction of 36% to 37% of inpatient visits and 47% to 50% of ED visits. The total number (inpatient, ED, ambulatory visits) of epilepsy-associated visits were reduced by 39% to 43% in the surgical group compared to the medically treated group. In those who had surgery, the average reduction in AEDs was 16% at 2 and 5 yr after treatment. Patients with refractory epilepsy treated with surgery had significant reductions in healthcare utilization compared with patients treated only with medications.
Sections du résumé
BACKGROUND
Pediatric refractory epilepsy affects quality of life, clinical disability, and healthcare costs for patients and families.
OBJECTIVE
To show the impact of surgical treatment for pediatric epilepsy on healthcare utilization compared to medically treated pediatric epilepsy over 5 yr.
METHODS
The Pediatric Health Information System database was used to conduct a cohort study using 5 published algorithms. Refractory epilepsy patients treated with antiepileptic medications (AEDs) only or AEDs plus epilepsy surgery between 1/1/2008 and 12/31/2014 were included. Healthcare utilization following the index date at 2 and 5 yr including inpatient, emergency department (ED), and all epilepsy-related visits were evaluated. The propensity scores (PS) method was used to match surgically and medically treated patients. PS. SAS® 9.4 and Stata 14.0 were used for data management and statistical analysis.
RESULTS
A total of 2106 (17.1%) and 10186 (82.9%) were surgically and medically treated. A total of 4050 matched cases, 2025 per each treated group, were included. Compared to medically treated patients, utilization was reduced in the surgical group: at 2 and 5 yr postindex date, there was a reduction of 36% to 37% of inpatient visits and 47% to 50% of ED visits. The total number (inpatient, ED, ambulatory visits) of epilepsy-associated visits were reduced by 39% to 43% in the surgical group compared to the medically treated group. In those who had surgery, the average reduction in AEDs was 16% at 2 and 5 yr after treatment.
CONCLUSION
Patients with refractory epilepsy treated with surgery had significant reductions in healthcare utilization compared with patients treated only with medications.
Identifiants
pubmed: 32710761
pii: 5876382
doi: 10.1093/neuros/nyaa307
doi:
Substances chimiques
Anticonvulsants
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E73-E82Informations de copyright
Copyright © 2020 by the Congress of Neurological Surgeons.