Direct and indirect costs associated with stereotactic radiosurgery or open surgery for medial temporal lobe epilepsy: Results from the ROSE trial

the ROSE Trial Study Group

Research output: Contribution to journalArticle

Abstract

Objective: To determine whether a less-invasive approach to surgery for medically refractory temporal lobe epilepsy is associated with lower health care costs and costs of lost productivity over time, compared to open surgery. Methods: We compared direct medical costs and indirect productivity costs associated with treatment with stereotactic radiosurgery (SRS) or anterior temporal lobectomy (ATL) in the ROSE (Radiosurgery or Open Surgery for Epilepsy) trial. Health care use was abstracted from hospital bills, the study database, and diaries in which participants recorded health care use and time lost from work while seeking care. Costs of use were calculated using a Medicare costing approach used in a prior study of the costs of ATL. The power of many analyses was limited by the sample size and data skewing. Results: Combined treatment and follow-up costs (in thousands of US dollars) did not differ between SRS (n = 20, mean = $76.6, 95% confidence interval [CI] = 50.7-115.6) and ATL (n = 18, mean = $79.0, 95% CI = 60.09-103.8). Indirect costs also did not differ. More ATL than SRS participants were free of consciousness-impairing seizures in each year of follow-up (all P < 0.05). Costs declined following ATL (P = 0.005). Costs tended to increase over the first 18 months following SRS (P = 0.17) and declined thereafter (P = 0.06). This mostly reflected hospitalizations for SRS-related adverse events in the second year of follow-up. Significance: Lower initial costs of SRS for medial temporal lobe epilepsy were largely offset by hospitalization costs related to adverse events later in the course of follow-up. Future studies of less-invasive alternatives to ATL will need to assess adverse events and major costs systematically and prospectively to understand the economic implications of adopting these technologies.

Original languageEnglish (US)
Pages (from-to)1453-1461
Number of pages9
JournalEpilepsia
Volume60
Issue number7
DOIs
StatePublished - Jul 1 2019

Fingerprint

Temporal Lobe Epilepsy
Radiosurgery
Epilepsy
Anterior Temporal Lobectomy
Costs and Cost Analysis
Hospitalization
Confidence Intervals
Delivery of Health Care
Medicare
Consciousness
Health Care Costs
Sample Size
Seizures
Economics
Databases

Keywords

  • costs
  • epilepsy
  • health care
  • lobectomy
  • radiosurgery

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

Direct and indirect costs associated with stereotactic radiosurgery or open surgery for medial temporal lobe epilepsy : Results from the ROSE trial. / the ROSE Trial Study Group.

In: Epilepsia, Vol. 60, No. 7, 01.07.2019, p. 1453-1461.

Research output: Contribution to journalArticle

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title = "Direct and indirect costs associated with stereotactic radiosurgery or open surgery for medial temporal lobe epilepsy: Results from the ROSE trial",
abstract = "Objective: To determine whether a less-invasive approach to surgery for medically refractory temporal lobe epilepsy is associated with lower health care costs and costs of lost productivity over time, compared to open surgery. Methods: We compared direct medical costs and indirect productivity costs associated with treatment with stereotactic radiosurgery (SRS) or anterior temporal lobectomy (ATL) in the ROSE (Radiosurgery or Open Surgery for Epilepsy) trial. Health care use was abstracted from hospital bills, the study database, and diaries in which participants recorded health care use and time lost from work while seeking care. Costs of use were calculated using a Medicare costing approach used in a prior study of the costs of ATL. The power of many analyses was limited by the sample size and data skewing. Results: Combined treatment and follow-up costs (in thousands of US dollars) did not differ between SRS (n = 20, mean = $76.6, 95{\%} confidence interval [CI] = 50.7-115.6) and ATL (n = 18, mean = $79.0, 95{\%} CI = 60.09-103.8). Indirect costs also did not differ. More ATL than SRS participants were free of consciousness-impairing seizures in each year of follow-up (all P < 0.05). Costs declined following ATL (P = 0.005). Costs tended to increase over the first 18 months following SRS (P = 0.17) and declined thereafter (P = 0.06). This mostly reflected hospitalizations for SRS-related adverse events in the second year of follow-up. Significance: Lower initial costs of SRS for medial temporal lobe epilepsy were largely offset by hospitalization costs related to adverse events later in the course of follow-up. Future studies of less-invasive alternatives to ATL will need to assess adverse events and major costs systematically and prospectively to understand the economic implications of adopting these technologies.",
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author = "{the ROSE Trial Study Group} and Langfitt, {John T.} and Mark Quigg and Guofen Yan and Wei Yu and Ward, {Mariann M.} and Nicholas Barbaro and Chang, {Edward F.} and Broshek, {Donna K.} and Laxer, {Kenneth D.} and Cole, {Andrew J.} and Sneed, {Penny K.} and Christopher Hess and Manjari Tripathi and Heck, {Christiaanne N.} and Miller, {John W.} and Garcia, {Paul A.} and Andrew McEvoy and Fountain, {Nathan B.} and Vicenta Salanova and Knowlton, {Robert C.} and Anto Bagić and Thomas Henry and Siddharth Kapoor and Guy McKhann and Palade, {Adriana E.} and Markus Reuber and Evelyn Tecoma",
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AU - Yan, Guofen

AU - Yu, Wei

AU - Ward, Mariann M.

AU - Barbaro, Nicholas

AU - Chang, Edward F.

AU - Broshek, Donna K.

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AU - Garcia, Paul A.

AU - McEvoy, Andrew

AU - Fountain, Nathan B.

AU - Salanova, Vicenta

AU - Knowlton, Robert C.

AU - Bagić, Anto

AU - Henry, Thomas

AU - Kapoor, Siddharth

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AU - Reuber, Markus

AU - Tecoma, Evelyn

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N2 - Objective: To determine whether a less-invasive approach to surgery for medically refractory temporal lobe epilepsy is associated with lower health care costs and costs of lost productivity over time, compared to open surgery. Methods: We compared direct medical costs and indirect productivity costs associated with treatment with stereotactic radiosurgery (SRS) or anterior temporal lobectomy (ATL) in the ROSE (Radiosurgery or Open Surgery for Epilepsy) trial. Health care use was abstracted from hospital bills, the study database, and diaries in which participants recorded health care use and time lost from work while seeking care. Costs of use were calculated using a Medicare costing approach used in a prior study of the costs of ATL. The power of many analyses was limited by the sample size and data skewing. Results: Combined treatment and follow-up costs (in thousands of US dollars) did not differ between SRS (n = 20, mean = $76.6, 95% confidence interval [CI] = 50.7-115.6) and ATL (n = 18, mean = $79.0, 95% CI = 60.09-103.8). Indirect costs also did not differ. More ATL than SRS participants were free of consciousness-impairing seizures in each year of follow-up (all P < 0.05). Costs declined following ATL (P = 0.005). Costs tended to increase over the first 18 months following SRS (P = 0.17) and declined thereafter (P = 0.06). This mostly reflected hospitalizations for SRS-related adverse events in the second year of follow-up. Significance: Lower initial costs of SRS for medial temporal lobe epilepsy were largely offset by hospitalization costs related to adverse events later in the course of follow-up. Future studies of less-invasive alternatives to ATL will need to assess adverse events and major costs systematically and prospectively to understand the economic implications of adopting these technologies.

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