Pediatric VNS Surgery: Pay Now or Pay More Later



BALTIMORE – "Pay now, save later" could be the motto in the case of vagus nerve stimulation surgery for young Medicaid patients who have intractable epilepsy.

In a study of 30-month outcomes in 445 children, vagus nerve stimulation (VNS) surgery had nearly paid for itself within a year, and began to save taxpayers money soon afterward, Dr. Sandra Helmers reported at the annual meeting of the American Epilepsy Society.

Dr. Sandra Helmers

"When we looked at the annual costs of emergency department and hospitalization before and after VNS surgery, we found that the overall cost savings began in the fifth or sixth quarter after surgery," and continued to increase in succeeding quarters, said Dr. Helmers, a neurologist at Emory University Hospital and Clinic, Atlanta. "This is the way we need to look at these treatments, in terms of real-world outcomes in both health and finances."

She and her colleagues divided the group of children by age: patients aged 1-11 years (238) and patients aged 12-17 years (207). All were Medicaid recipients.

Among the younger group, the mean age at the time of surgery was 7 years. All had still been having seizures despite medical therapy. They had tried a mean of four antiepileptic drugs before surgery, and 63% were on polytherapy.

The mean age at the time of surgery in the older group was 15 years. They had tried a mean of four antiepileptic drugs before surgery, and 64% were on polytherapy.

The cost of the surgery ranged from about $20,000 to $30,000, which is "fairly high relative to the preimplant costs," Dr. Helmers said.

But it didn’t take long before the savings began to show, in terms of decreased hospital and ED visits, she said. In the first 6 months after the surgery, the younger patients were 27% less likely to have an ED visit and 26% less likely to have a hospital admission than they were in the prior 6 months. The surgery resulted in savings, but the overall costs were not quite statistically significant ($17,831 vs. $18,220 quarterly [P = .052]) in the 6 months before and after surgery.

During their 6-month postsurgery period, older patients were 57% less likely to go to the ED and 56% less likely to have a hospital admission. Average total health care costs were significantly lower in the 6 months after surgery than the 6 months before ($14,068 vs. $19,047 quarterly [P = .002]).

Although VNS surgery did positively affect hospitalizations, it did not significantly change the number of antiepileptic drugs the children took, Dr. Helmers noted. "We can’t really say anything about adding new medications, because these were refractory patients and for them, another trial of medicine typically does not give much benefit."

The findings are encouraging, because they show that the short-term expense of stabilizing children’s intractable epilepsy brings long-term savings.

"It is difficult for these children to get this intervention. Health insurance is the major barrier to good care for epilepsy. And if you don’t have insurance, you are unlikely to get this."

Policy makers need to know this kind of information, she said. "This pays off [in the United States] just as it has been shown to in other parts of the world. In our country we don’t use data like these to dictate policy – but that is coming. How that will play out in the future is something we still don’t know."

Dr. Helmers had no financial disclosures.

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