Joglekar R, Garner A, Gillespie J, Ramirez B, Pietzsch JB. Cost-Effectiveness of deep brain stimulation for epilepsy in Australia [abstract PD70; p 213]. Poster presentation at the 2018 annual meeting of Health Technology Assessment International, Vancouver, BC, Canada, 1–5 June 2018. In HTAi 2018 Annual Meeting, Vancouver, Canada: Strengthening the Evidence-to-Action Connection; Abstract Book. Edmonton, AB, Canada: Health Technology Assessment International, 2018. Available online Accessed February 4, 2022

Objectives. Deep brain stimulation (DBS), which uses an implantable device to modulate brain activity, is an adjunctive treatment for partial-onset seizures in patients with medically refractory epilepsy. Our objective was to perform an exploratory cost-utility analysis of DBS in conjunction with medical therapy compared to medical therapy alone, using latest clinical data and costs for the Australian healthcare system.

Materials and Methods. A deterministic five-state Markov model was used to project treatment response and outcomes over the patients’ lifetime, based on 5-year data from the SANTE DBS randomized control trial and drug outcome data identified through literature search. Costs were based on 2017 data for the Australian healthcare system, and response-specific utilities derived from published literature. We estimated the lifetime discounted incremental cost-effectiveness ratio (ICER) in Australian dollars per quality-adjusted life-year (QALY) for patients 36 years of age, 55% of whom were male. Costs and effects were discounted at 5% per annum. The robustness of projections was evaluated through scenario and sensitivity analyses.

Results. Under assumed continued treatment benefit, DBS was projected to add 3.48 QALYs over the patients’ lifetime, at increased cost of $142,304 ($244,408 vs. $142,304), resulting in an ICER of $40,951 per QALY gained. Reducing the analysis horizon to15 years increased the ICER to $59,911. Increasing DBS generator life from 3 to 6 years decreased the ICER to $23,956 per QALY. Longer follow-up periods and younger treatment age were associated with greater cost-effectiveness. Results were sensitive to assumptions about health state-specific utility estimates and long-term treatment effect.

Discussion. Our study, based on outcomes from a large-scale controlled clinical trial,found DBS to be associated with substantial gains in health-related quality of life over the horizon of the analysis, primarily as a result of improvements in responder rate (defined as 50% improvement vs. baseline). The corresponding QALY gain leads to an attractive cost-effectiveness ratio despite the projected higher costs of DBS. Several limitations of our study exist, among them use of seizure frequency as the relevant outcome to assess treatment benefits, while quality of life might also depend on seizure severity and length of seizure-free periods. Further, no head-to-head comparison data are available to-date.

Conclusions. Our exploratory findings suggest that DBS is a cost-effective treatment strategy for patients with medically refractory epilepsy in the Australian healthcare system. DBS therapy might meaningfully improve patient outcome at a health-economic profile that compares favorably to other well-accepted therapies. Consideration of indirect societal costs would further add to this value proposition.