Comparison of healthcare resource utilization in pediatric patients with refractory epilepsy: Vagus nerve stimulation and medical treatment cohorts

Lu Zhang; Joyce Y Wu; Sandi K Lam

doi:10.1016/j.yebeh.2021.108281

Comparison of healthcare resource utilization in pediatric patients with refractory epilepsy: Vagus nerve stimulation and medical treatment cohorts

Epilepsy Behav. 2021 Oct:123:108281. doi: 10.1016/j.yebeh.2021.108281. Epub 2021 Sep 9.

Authors

Lu Zhang¹, Joyce Y Wu², Sandi K Lam³

Affiliations

¹ Division of Pediatric Neurosurgery, Ann & Robert Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA.
² Division of Pediatric Neurology, Department of Pediatrics, Ann & Robert Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA.
³ Division of Pediatric Neurosurgery, Ann & Robert Lurie Children's Hospital of Chicago, 225 E Chicago Ave, Chicago, IL 60611, USA; Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 28, Chicago, IL 60611, USA. Electronic address: slam@luriechildrens.org.

PMID: 34509035
DOI: 10.1016/j.yebeh.2021.108281

Abstract

Objectives: Refractory epilepsy imposes a substantial burden on affected patients, families, and healthcare system. In terms of treating seizures in children, vagus nerve stimulation (VNS) has been proved to be comparable to that of antiepileptic drugs (AEDs). This study compared healthcare resource utilization between pediatric patients treated with AEDs only and AEDs plus VNS.

Methods: Pediatric patients diagnosed with refractory epilepsy between the 1st of January 2011 and the 31st of December 2016 were identified from the Pediatric Health Information System Database. Patients treated with AEDs only or AEDs plus VNS were included in the study and were followed up from one year before to two years after the date when defined criteria for refractory epilepsy were met. The difference-in-difference approach along with the hurdle model was used to compare the changes in healthcare resource utilization over time between patients treated with AEDs only and AEDs plus VNS.

Results: The study included 1502 patients treated with AEDs plus VNS and 4541 patients treated with AEDs only. There was a difference in post-index all-cause and epilepsy-related inpatient visits compared to the pre-index period: inpatient hospitalizations were decreased in the AEDs plus VNS cohort, and increased in the AEDs only cohort. There was no significant difference in the pre-index to post-index change for all-cause and epilepsy-related emergency department visits between the two treatment cohorts. For outpatient encounters in the initial post-index period, patients treated with AEDs plus VNS had significantly higher increase in all-cause and epilepsy-related outpatient visits compared to the AEDs only cohort.

Conclusions: Compared to those treated with AEDs only, pediatric patients with refractory epilepsy treated with AEDs plus VNS have fewer inpatient visits and more outpatient visits within a 2-year follow-up. Given the lower acuity of care in outpatient versus inpatient settings, this study can inform treatment choices for children with refractory epilepsy.

Keywords: Healthcare resource utilization; Pediatric patients; Refractory epilepsy; Vagus nerve stimulation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anticonvulsants / therapeutic use
Child
Drug Resistant Epilepsy* / drug therapy
Epilepsy* / drug therapy
Humans
Patient Acceptance of Health Care
Retrospective Studies
Treatment Outcome
Vagus Nerve
Vagus Nerve Stimulation*

Substances

Anticonvulsants