Impact of Vagus Nerve Stimulation for the Treatment of Drug-resistant Epilepsy on Patterns of Use and Cost of Health Care Services and Pharmacotherapy: Comparisons of the 24-Month Periods Before and After Implantation

• Published in: Clinical therapeutics Vol. 45; no. 2; pp. 136 - 150
• Main Authors: Evans, Kathryn, Stamas, Nicole, Li, Qian, Vincent, Tom, Halchenko, Yuliya, Zhang, Lu, Danielson, Vanessa, Murphy, Joanna, Barion, Francesca, Lam, Sandi, Lassagne, Reginald, Berger, Ariel
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2023; Elsevier Limited
• Subjects: Cardiovascular disease; Comorbidity; Convulsions & seizures; Cost analysis; Cost control; Drug resistance; Drug Resistant Epilepsy - therapy; Drug therapy; drug-resistant epilepsy; Emergency medical care; Emergency medical services; Epilepsy; Epilepsy - therapy; health care cost; Health Care Costs; Health care expenditures; Health care policy; health care utilization; Health services; Health services utilization; Humans; Implantation; Mortality; Nerves; neurostimulation; Patients; Pharmacology; Pharmacy; Prescription drugs; Quality of Life; Regression analysis; Retrospective Studies; Risk reduction; Seizures; Sensitivity analysis; Stimulation; Subgroups; Surgery; Treatment Outcome; Vagus nerve; vagus nerve stimulation; Vagus Nerve Stimulation - methods; United States > US; drug-resistant epilepsy; epilepsy; health care utilization; vagus nerve stimulation; health care cost; neurostimulation
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2023.01.007

This study examines the impact of vagus nerve stimulation (VNS) as treatment for drug-resistant epilepsy (DRE) on the use and cost of health care services and pharmacotherapy. Using a large US health care claims database, we identified all patients with DRE who underwent VNS between January 1, 2012 and December 31, 2019. VNS implantation date was designated as the index date, and patients had to be continuously enrolled for the 24-month period before this date (preindex period). Outcomes included all-cause and epilepsy-related hospitalization, emergency department (ED) visits, and health care costs; health care claims resulting in an epilepsy diagnosis and all claims for antiseizure medications were deemed epilepsy related. Preindex data, except care related to preoperative medical clearance for VNS, were used to estimate multivariate regression models predicting outcomes during the 24-month postindex period (follow-up period). Predicted outcomes during follow-up were then compared with observed values. As a sensitivity analysis, we also replicated all analyses among subgroups defined by comorbid depression. A total of 659 patients underwent VNS for DRE and met the selection criteria. For the composite outcome of all-cause hospitalizations and ED visits, observed values were 42% lower than expected during the 24-month follow-up period; for the composite outcome of epilepsy-related hospitalizations and ED visits, observed values were 49% lower (P < 0.001 for both). Observed mean total all-cause costs, inclusive of costs of the procedure, were not significantly different than expected costs by month 19 of follow-up; mean total epilepsy-related costs were comparable by month 18. Findings were similar in subgroups with and without depression, although nominally greater differences (observed – expected) were seen in those with comorbid depression. Our findings suggest that VNS is associated with decreased risk of hospitalization or ED visits (all cause and epilepsy related) during the 2-year period subsequent to implantation and may become cost-neutral within 2 years of implantation (vs continued medical management of DRE without VNS). Although expected outcomes were estimated based on the 24-month period before implantation, the degree to which they approximated what would have happened in the absence of VNS is unknowable. Further research is needed to better understand the extend and duration of the impact of VNS on seizure frequency and severity and health-related quality of life, including its performance among those with and without comorbid depression.