Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, IRCCS Bambino Gesù Children Hospital, Rome, Italy.
Epilepsia. 2013 Oct;54 Suppl 7:49-58. doi: 10.1111/epi.12309.
Epilepsy is a neurologic disorder with major social impact. Surgery is a valuable option in patients who are not responding to antiepileptic drugs. The literature reports demonstrate that a proportion ranging from 40 to 100% of patients with epilepsy achieve seizure remission after surgery. A presurgical evaluation (clinical and instrumental) must be performed in all patients with drug-resistant epilepsy to assess their suitability for surgical intervention. Health Technology Assessment (HTA) represents a modern approach to the analysis of technologies used for health care. HTA could be considered a bridge between science that produces evidence and the decisions that can be taken on the basis of that evidence at different levels of the health care system. The aim of this study is the HTA of epilepsy surgery including clinical, ethical, social, and economic features.
The present study includes an analysis of the diagnostic and surgical workup performed at the Italian centers for the diagnosis and treatment of drug-resistant epilepsy (DRE). The study includes the following issues: (1) social, ethical impact, and costs of the disease; (2) clinical results, efficacy, and safety of surgery; (3) ethics and quality of life after surgery; and (4) economic impact and productivity regained after surgery. The cost of managing a patient with DRE included in the presurgical study was estimated by the bottom-up microcosting technique that starts from a detailed collection of data on consumption of resources and full costing. The phases analyzed were (1) noninvasive diagnostic workup; (2) neurosurgical intervention; and (3) follow-up.
The literature reports indicate epilepsy surgery as an effective treatment both on clinical results and on ethical, social, and quality of life aspects. The workup including the noninvasive presurgical study followed by surgery has a total cost of €20,827. Management of short-term follow-up increases the overhead to €22,291 at the first year, and then to €23,571 after 5 years. According to the estimates made in this survey, funding based on diagnosis-related group (DRG) tariff for the noninvasive diagnostic stage involving hospital admission is not remunerative in Italy either at regional or national levels. Effectively the difference between full cost and DRG has a delta of €3,402 and €2,537 respectively. The total cost of the presurgical, surgical, and follow-up evaluation is not remunerative for €10,554 (national data).
Economic surveys in Italy have shown that surgery for DRE is an advantageous treatment from the standpoint of third-party payers and is cost-effective for society. DRE presurgical evaluation and surgery are not remunerative either at regional or national levels.
癫痫是一种具有重大社会影响的神经障碍。对于对抗癫痫药物无反应的患者，手术是一种有价值的选择。文献报道显示，在接受手术的癫痫患者中，有 40%至 100%的患者可实现癫痫缓解。所有耐药性癫痫患者都必须进行术前评估（临床和仪器评估），以评估其接受手术干预的适宜性。卫生技术评估（HTA）是一种用于分析医疗保健技术的现代方法。HTA 可以被视为连接产生证据的科学与在医疗保健系统不同层次上基于该证据做出的决策之间的桥梁。本研究的目的是对包括临床、伦理、社会和经济特征在内的癫痫手术进行 HTA。
本研究包括对意大利耐药性癫痫（DRE）诊断和治疗中心进行的诊断和手术检查的分析。该研究包括以下内容：（1）疾病的社会、伦理影响和成本；（2）手术的临床结果、疗效和安全性；（3）手术后的伦理和生活质量；（4）手术后的经济影响和生产力恢复。使用自下而上的微观成本核算技术估算了纳入术前研究的 DRE 患者的管理成本，该技术从对资源消耗和全额成本的详细数据收集开始。分析的阶段包括（1）非侵入性诊断工作；（2）神经外科干预；和（3）随访。
文献报道表明，癫痫手术在临床结果以及伦理、社会和生活质量方面都是一种有效的治疗方法。包括术前非侵入性研究在内的手术检查总费用为 20827 欧元。短期随访管理将管理费用增加到第一年的 22291 欧元，五年后增加到 23571 欧元。根据本调查中的估计，意大利的按诊断相关组（DRG）收费对涉及住院的非侵入性诊断阶段的资金支持是没有回报的，无论是在地区还是国家层面。实际上，全额成本与 DRG 之间的差额分别为 3402 欧元和 2537 欧元。术前、手术和随访评估的总费用在国家层面上对 10554 欧元没有回报。
意大利的经济调查显示，对于第三方支付者来说，DRE 的手术治疗是一种有利的治疗方法，并且对社会具有成本效益。DRE 的术前评估和手术在地区和国家层面都没有回报。
