VNS Added to Antiseizure Medication Appears Cost Effective for Drug-Resistant Epilepsy

Vagus nerve stimulation (VNS) in addition to antiseizure medication is highly likely to be cost effective for patients with drug-resistant epilepsy, according to a study published online in the Journal of Medical Economics.

“Around a third of epilepsy patients fail to achieve an adequate response to antiseizure medications and may be eligible to receive vagus nerve stimulation therapy for their drug-resistant epilepsy if they are unsuited to surgery… However, there has to date been no comprehensive cost effectiveness evaluation of VNS within the US setting,” wrote corresponding author Christopher Raspin of Symmetron Limited, London, United Kingdom, and coauthors in the study introduction.

For the study, researchers modeled costs associated with VNS as an add-on to antiseizure medications using a US Medicare perspective. Factored costs included the VNS device costs, medication costs, adverse event costs associated with VNS, and costs associated with seizures.

In the base case, treatment with VNS added to antiseizure medication was associated with a 0.385 gain in quality-adjusted life years and a per-patient savings of $109,678 over a 10-year time horizon compared with ASM therapy alone, according to the study. At a threshold of $50,000 per quality-adjusted life year, the incremental net monetary benefit was $128,903, positioning VNS as highly cost effective.

“VNS may reduce the number of seizures, and subsequently improve patient quality of life and result in substantially lower costs for Medicare (eg, in emergency and hospital care for a person having a seizure),” researchers wrote.

Citing some uncertainty in how VNS reduces disabling seizure and its impact on quality of life and health care costs, the authors cautioned their findings should be considered exploratory until further data are available.

“This said,” they added, “a wide range of potential scenarios, including a scenario whereby the cost of providing VNS was increased substantially, were modeled, and results consistently indicated that VNS was more cost effective than antiseizure medications alone.”

Reference

Raspin C, Faught E, Armand J, et al. An economic evaluation of vagus nerve stimulation as an adjunctive treatment to anti-seizure medications for the treatment of drug resistant epilepsy in the United States. J Med Econ. 2023;26(1):189-199. doi:10.1080/13696998.2023.2171230