Mansouri Alireza, Aldakkan Abdulrahman, Kosicka Magda J, Tarride Jean-Eric, Valiante Taufik A
Division of Neurosurgery, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University Health Network, Toronto, ON, Canada M5T 2S8; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada L8P 1H1.
Division of Neurosurgery, University of Toronto, Toronto, ON, Canada; Toronto Western Hospital, University Health Network, Toronto, ON, Canada M5T 2S8; Division of Neurosurgery, King Saud University, Riyadh, Saudi Arabia.
Epilepsy Res Treat. 2015;2015:675071. doi: 10.1155/2015/675071. Epub 2015 Dec 7.
Objective. Surgery for medically refractory epilepsy (MRE) in adults has been shown to be effective but underutilized. Comprehensive health economic evaluations of surgery compared with continued medical management are limited. Policy changes may be necessary to influence practice shift. Methods. A critical review of the literature on health economic analyses for adults with MRE was conducted. The MEDLINE, EMBASE, CENTRAL, CRD, and EconLit databases were searched using relevant subject headings and keywords pertaining to adults, epilepsy, and health economic evaluations. The screening was conducted independently and in duplicate. Results. Four studies were identified (1 Canadian, 2 American, and 1 French). Two were cost-utility analyses and 2 were cost-effectiveness evaluations. Only one was conducted after the effectiveness of surgery was established through a randomized trial. All suggested surgery to be favorable in the medium to long term (7-8 years and beyond). The reduction of medication use was the major cost-saving parameter in favor of surgery. Conclusions. Although updated evaluations that are more generalizable across settings are necessary, surgery appears to be a favorable option from a health economic perspective. Given the limited success of knowledge translation endeavours, funder-level policy changes such as quality-based purchasing may be necessary to induce a shift in practice.
目的。已证明成人药物难治性癫痫（MRE）手术有效，但未得到充分利用。与持续药物治疗相比，手术的综合卫生经济评估有限。可能需要政策改变来影响实践转变。方法。对有关成人MRE卫生经济分析的文献进行了批判性综述。使用与成人、癫痫和卫生经济评估相关的主题词和关键词检索MEDLINE、EMBASE、CENTRAL、CRD和EconLit数据库。筛选工作独立进行且重复进行。结果。共确定了四项研究（1项加拿大研究、2项美国研究和1项法国研究）。两项是成本效用分析，两项是成本效益评估。只有一项是在通过随机试验确定手术有效性之后进行的。所有研究均表明手术在中长期（7 - 8年及以后）是有利的。减少药物使用是支持手术的主要成本节约参数。结论。尽管需要更适用于不同情况的最新评估，但从卫生经济角度来看，手术似乎是一个有利的选择。鉴于知识转化努力取得的成功有限，可能需要资助者层面的政策改变，如基于质量的采购，以促使实践发生转变。
