The cost-effectiveness of stereo-electroencephalography (SEEG) for people with refractory epilepsy: A decision model analysis

Abstract

Objective Stereo-electroencephalography (SEEG) is a promising diagnostic technique that is able to localise the focal point of seizure activity in patients with refractory epilepsy who would otherwise not be eligible for surgery. The objective of this study was to determine the long term cost-effectiveness of SEEG. Methods A decision model was developed to compare the costs and health outcomes associated with SEEG, as compared to usual care with anti-epileptic drugs. Data on patient clinical outcomes was obtained from the Mater Advanced Epilespy Unit. A ten year time horizon was adopted and direct health care costs were valued from the perspective of the Australian health care system. Patient health benefits in terms of quality adjusted life years (QALYs). A probabilistic sensitivity analysis was conducted to determine the impacts of uncertainty in the model parameters. Lessons Learned The base case analysis produced an incremental cost-effectiveness ratio for SEEG of $22,925 per QALY, falling below the cost-effectiveness threshold of$28,000 per QALY. The probabilistic sensitivity analysis indicated there was a 79% chance of the technology being cost-effective once uncertainty in the data was taken into account. Implications In Australia, SEEG is not reimbursed under current public funding mechanisms and a large treatment gap exists. This study provides evidence to suggest that SEEG represents a high value use of health care resources when the long term costs and consequences of epilepsy are taken into account. This points to the need for a new DRG code to be created for this procedure