University of Pécs, Centre for Health Technology Assessment, Pécs, Rákóczi u. 2., H-7623, Hungary; University of Pécs, Faculty of Pharmacy, Division of Pharmacoeconomics, Department of Pharmaceutics, Pécs, Rákóczi u. 2., H-7623, Hungary.
University of Pécs, Medical School, Department of Neurology, Pécs, Rét u. 2., H-7623, Hungary.
Epilepsy Behav. 2021 Jan;114(Pt A):107488. doi: 10.1016/j.yebeh.2020.107488. Epub 2020 Nov 27.
Our aim was to determine the cost-effectiveness of two intracranial electroencephalography (iEEG) interventions: 1) stereoelectroencephalography (SEEG) and 2) placement of subdural grid electrodes (SDGs) both followed by resective surgery in patients with drug-resistant, partial-onset epilepsy, compared with medical management (MM) in Hungary from payer's perspective.
The incremental health gains and costs of iEEG interventions have been determined with a combination of a decision tree and prevalence Markov process model over a 30-year time horizon in a cost-utility analysis (CUA). To address the effect of parameter uncertainty on the incremental cost-effectiveness ratio (ICER), deterministic and probabilistic sensitivity analyses were performed.
Our results showed that both SEEG and SDG interventions represent a more expensive but more effective strategy than MM representing the current standard of care. The total discounted cost of SEEG and SDG were € 32,760 and € 25,028 representing € 18,108 and € 10,375 additional cost compared with MM, respectively. However, they provide an additional 3.931 (in SEEG group) and 3.444 quality-adjusted life years (QALYs; in SDG group), correspondingly. Thus, the ICER of SEEG is € 4607 per QALY gain, while the ICER for SDG is € 3013 per QALY gain, compared with MM. At a cost-effectiveness threshold of € 41,058 per QALY in Hungary, both subtypes of iEEG interventions are cost-effective and provide good value for money.
Because of the high cost of implanting electrodes and monitoring, the invasive EEG for patients with refractory epilepsy is currently not available in the Hungarian national healthcare system. Our study demonstrated that these procedures in Hungary are cost-effective compared with the MM. As a result, the introduction of iEEG interventions to the reimbursement list of the National Health Insurance Fund Administration was initiated.
本研究旨在从支付者的角度，比较耐药性部分性癫痫患者接受两种颅内脑电图（iEEG）干预措施（1）立体脑电图（SEEG）和（2）植入硬膜下网格电极（SDG），并随后行切除术与药物治疗（MM）的成本效益。
通过决策树和流行马尔可夫过程模型，结合成本效用分析（CUA），确定 iEEG 干预的增量健康收益和成本。为了解决参数不确定性对增量成本效益比（ICER）的影响，进行了确定性和概率敏感性分析。
我们的结果表明，与当前的标准治疗相比，SEEG 和 SDG 干预均代表了更昂贵但更有效的策略。SEEG 和 SDG 的总贴现成本分别为 32760 欧元和 25028 欧元，与 MM 相比，分别增加了 18108 欧元和 10375 欧元。然而，它们分别提供了额外的 3.931 个（SEEG 组）和 3.444 个质量调整生命年（QALY）。因此，SEEG 的 ICER 为每 QALY 增加 4607 欧元，而 SDG 的 ICER 为每 QALY 增加 3013 欧元，与 MM 相比。在匈牙利，每 QALY 成本效益阈值为 41058 欧元，两种 iEEG 干预均具有成本效益，并且物有所值。
由于植入电极和监测的成本较高，匈牙利国家卫生保健系统目前无法为难治性癫痫患者提供侵入性脑电图。我们的研究表明，与 MM 相比，这些程序在匈牙利具有成本效益。因此，国家健康保险基金管理局将 iEEG 干预措施引入报销清单。
