Boon P, Vonck K, D'Have M, O'Connor S, Vandekerckhove T, De Reuck J
Department of Neurology, University Hospital, Gent, Belgium.
Acta Neurol Belg. 1999 Dec;99(4):275-80.
Vagus nerve stimulation (VNS) is an established treatment for patients with medically refractory epilepsy who are unsuitable candidates for conventional epilepsy surgery. VNS requires an initial financial investment but apart from our own previous study there are no reports on cost-benefit published to date. The purpose of this paper is to assess prospectively the cost-benefit ratio of VNS in a series of patients with long term follow-up.
Our experience with VNS comprises 25 patients of whom 20 with sufficient follow-up will be further discussed. These 20 patients have a mean post-implantation follow-up of 26 months (range: 6-50 months). Mean age was 30 years (range: 12-45 years); mean duration of epilepsy 17 years (range: 5-35 years). We prospectively assessed seizure frequency, prescribed AEDs, number of hospital admission days and side effects and calculated the epilepsy related direct medical cost and compared this with pre-implantation data.
Mean seizure frequency decreased from 14 seizures/month (range: 2-40) to 9 seizures/month (range: 0-30) (p = 0.0003). The mean yearly epilepsy related direct medical costs per patient dropped from 6,682 USD (range: 829-21,888 USD) to 3,635 USD (range: 684-12,486 USD) (p = 0.0046). The mean number of hospital admission days was reduced from 16 days/year (range: 0-60) to 4 days/year (range: 0-30) (p = 0.0029).
VNS is an efficacious and cost-beneficial treatment for refractory partial seizures.
迷走神经刺激术（VNS）是一种针对药物治疗难治性癫痫且不适合传统癫痫手术的患者的既定治疗方法。VNS需要初始资金投入，但除了我们之前的研究外，迄今尚无关于成本效益的报道。本文旨在对一系列长期随访患者的VNS成本效益比进行前瞻性评估。
我们对VNS的经验包括25例患者，其中20例有足够的随访资料将进一步讨论。这20例患者植入后的平均随访时间为26个月（范围：6 - 50个月）。平均年龄为30岁（范围：12 - 45岁）；癫痫平均病程为17年（范围：5 - 35年）。我们前瞻性评估了癫痫发作频率、处方抗癫痫药物、住院天数和副作用，并计算了癫痫相关的直接医疗费用，并将其与植入前的数据进行比较。
平均癫痫发作频率从每月14次发作（范围：2 - 40次）降至每月9次发作（范围：0 - 30次）（p = 0.0003）。每位患者每年癫痫相关的直接医疗费用从6682美元（范围：829 - 21888美元）降至3635美元（范围：684 - 12486美元）（p = 0.0046）。平均住院天数从每年16天（范围：0 - 60天）降至每年4天（范围：0 - 30天）（p = 0.0029）。
VNS是治疗难治性部分性癫痫的一种有效且具有成本效益的治疗方法。
