An Initial Cost-Effectiveness Analysis of Magnetic Resonance-Guided Laser Interstitial Thermal Therapy in Pediatric Epilepsy Surgery.

MedStar author(s):
Citation: Pediatric Neurosurgery. 55(3):141-148, 2020.PMID: 32829333Institution: MedStar Washington Hospital CenterDepartment: NeurosurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Cost-Benefit Analysis/mt [Methods] | *Drug Resistant Epilepsy/su [Surgery] | *Hyperthermia, Induced/mt [Methods] | *Intraoperative Neurophysiological Monitoring/mt [Methods] | *Laser Therapy/mt [Methods] | *Magnetic Resonance Imaging/mt [Methods] | Adolescent | Child | Child, Preschool | Drug Resistant Epilepsy/dg [Diagnostic Imaging] | Drug Resistant Epilepsy/ec [Economics] | Extracellular Fluid/ph [Physiology] | Female | Follow-Up Studies | Humans | Hyperthermia, Induced/ec [Economics] | Intraoperative Neurophysiological Monitoring/ec [Economics] | Laser Therapy/ec [Economics] | Magnetic Resonance Imaging/ec [Economics] | Male | Retrospective Studies | Young AdultYear: 2020ISSN:
  • 1016-2291
Name of journal: Pediatric neurosurgeryAbstract: CONCLUSION: Our data suggests that MRgLITT may be a cost-effective alternative to traditional surgical resection in pediatric epilepsy surgery. Copyright (c) 2020 S. Karger AG, Basel.INTRODUCTION: Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a new technology that provides a clinically efficacious and minimally invasive alternative to conventional microsurgical resection. However, little data exist on how costs compare to traditional open surgery. The goal of this paper is to investigate the cost-effectiveness of MRgLITT in the treatment of pediatric epilepsy.METHODS: We retrospectively analyzed the medical records of pediatric patients who underwent MRgLITT via the Visualase R thermal therapy system (Medtronic, Inc., Minneapolis, MN, USA) between December 2013 and September 2017. Direct costs associated with preoperative, operative, and follow-up care were extracted. Benefit was calculated in quality-adjusted life years (QALYs), and the cost-effectiveness was derived from the discounted total direct costs over QALY. Sensitivity analysis on 4 variables was utilized to assess the validity of our results.RESULTS: Twelve consecutive pediatric patients with medically refractory epilepsy underwent MRgLITT procedures. At the last postoperative follow-up, 8 patients were seizure free (Engel I, 66.7%), 2 demonstrated significant improvement (Engel II, 16.7%), and 2 patients showed worthwhile improvement (Engel III, 16.7%). The average cumulative discounted QALY was 2.11 over the lifetime of a patient. Adjusting for inflation, MRgLITT procedures had a cost-effectiveness of USD 22,211 per QALY. Our sensitivity analysis of cost variables is robust and supports the procedure to be cost--effective.All authors: Alexander H, Fayed I, Huang SS, Keating RF, Oluigbo CO, Sacino MOriginally published: Pediatric Neurosurgery. :1-8, 2020 Aug 23Fiscal year: FY2021Digital Object Identifier: Date added to catalog: 2020-09-02
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Journal Article MedStar Authors Catalog Article 32829333 Available 32829333

CONCLUSION: Our data suggests that MRgLITT may be a cost-effective alternative to traditional surgical resection in pediatric epilepsy surgery. Copyright (c) 2020 S. Karger AG, Basel.

INTRODUCTION: Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) is a new technology that provides a clinically efficacious and minimally invasive alternative to conventional microsurgical resection. However, little data exist on how costs compare to traditional open surgery. The goal of this paper is to investigate the cost-effectiveness of MRgLITT in the treatment of pediatric epilepsy.

METHODS: We retrospectively analyzed the medical records of pediatric patients who underwent MRgLITT via the Visualase R thermal therapy system (Medtronic, Inc., Minneapolis, MN, USA) between December 2013 and September 2017. Direct costs associated with preoperative, operative, and follow-up care were extracted. Benefit was calculated in quality-adjusted life years (QALYs), and the cost-effectiveness was derived from the discounted total direct costs over QALY. Sensitivity analysis on 4 variables was utilized to assess the validity of our results.

RESULTS: Twelve consecutive pediatric patients with medically refractory epilepsy underwent MRgLITT procedures. At the last postoperative follow-up, 8 patients were seizure free (Engel I, 66.7%), 2 demonstrated significant improvement (Engel II, 16.7%), and 2 patients showed worthwhile improvement (Engel III, 16.7%). The average cumulative discounted QALY was 2.11 over the lifetime of a patient. Adjusting for inflation, MRgLITT procedures had a cost-effectiveness of USD 22,211 per QALY. Our sensitivity analysis of cost variables is robust and supports the procedure to be cost--effective.

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