Model Explores Treatment Cost Effectiveness in Lennox-Gastaut Syndrome

In a recently published research paper¹ in the journal Epilepsia Open, a team from the UPMC Children’s Hospital of Pittsburgh Epilepsy Center and the University of Pittsburgh School of Medicine report findings on the comparative cost effectiveness of vagus nerve stimulation (VNS) and corpus callosotomy to treat drug-resistant seizures resulting from Lennox-Gastaut Syndrome.

The study was co-authored by Taylor J. Abel, MD, chief of Pediatric Epilepsy Surgery and surgical director of the UPMC Children’s Epilepsy Center, and William P. Welch, MD, assistant professor of Child Neurology and director of Epilepsy Neurostimulation at UPMC Children’s. Joining Drs. Abel and Welch in the study were University of Pittsburgh School of Medicine student Madison Remick, and Kenneth J. Smith, MD, MS, professor of Medicine and Clinical and Translational Science at the University of Pittsburgh School of Medicine.

Study Overview and Important Findings

Lennox-Gastaut Syndrome (LGS) typically arises in early childhood or infancy and is characterized by drug-resistant seizures that vary by the individual and typically involve tonic, atonic, and/or atypical absent seizures. While in the majority of cases a definitive cause can be identified, approximately 20% of cases have no identifiable instigator. Even less is known about the mechanistic processes involved in driving seizure types and patterns in individual cases. Cognitive impairments and delays in development are frequent morbidities seen in the LGS patient population.

Surgical approaches such as corpus callosotomy or the use of implantable neurostimulation devices can provide significant reductions or elimination of seizures in some individuals. However, not all individuals are candidates for surgery or neurostimulation, and outcomes related to seizure reduction or elimination are variable.

At present, there is no consensus in the field as to which approach provides the best outcomes. Corpus callosotomy and VNS can both provide degrees of seizure relief, but each has its own set of risks and potential complications. Corpus callosotomy may confer greater reductions in seizures than vagus nerve stimulation, but with the potential for higher risk and more profound postoperative complications.

The new study by Drs. Abel, Welch, and colleagues sought to determine which approach to treating seizures resulting from LGS is the most cost-effective approach relative to outcomes and surgical complications.

The team developed a cost-effectiveness analytic model to compare costs of care during the first year after each respective intervention.

Their analysis found that while corpus callosotomy was associated with better control of seizures, vagus nerve stimulation provided the more cost-effective approach.

The results point in the direction of potentially considering vagus nerve stimulation as the initial approach to control a patient's seizures. However, additional studies will be required to further explore the longer-term financial implications of each approach, as well as better understand how cognitive function may be positively or negatively affected by each approach over the long-term.

Learn more about the study's findings and the modeling technique the team developed by reading the full article using the reference link below.

Learn more about Dr. Abel, Dr. Welch, and the UPMC Children’s Hospital of Pittsburgh Epilepsy Center.

Reference

1. Abel TJ, Remick M, Welch WC, Smith KJ. One-year Cost-effectiveness of Callosotomy vs Vagus Nerve Stimulation for Drug-resistant Seizures in Lennox-Gastaut Syndrome: A Decision Analytic Model. Epilepsia Open. 2022 Mar; 7(1): 124-130.