Langfitt J T
Department of Neurology, University of Rochester, New York, USA.
Epilepsia. 1997 Feb;38(2):154-63. doi: 10.1111/j.1528-1157.1997.tb01091.x.
The value of high-cost health technologies is being increasingly scrutinized by providers of health care. An understanding of the costs and outcomes of high-technology epilepsy care is required to ensure efficient resource allocation.
Decision analysis was used to estimate the cost effectiveness of anterotemporal lobectomy (ATL) as compared with standard medical management in medically-intractable epilepsy. Local (Rochester, NY, U.S.A.) cost data were applied to a model of lifetime discounted costs and outcomes of evaluation, ATL, and follow-up in a hypothetical cohort of patients.
Base case analysis yielded a marginal cost-effectiveness ratio (MECR) of $15.581/quality-adjusted life year (QALY). Extensive sensitivity analyses identified extreme conditions in which evaluation for ATL was dominant (more effective and less costly) or in which it might be considered not worth the cost (MCER > $50,000/QALY).
Estimates of ATL cost effectiveness fall within a generally acceptable range, even when uncertainty about many model parameters is taken into account. Under assumptions based on available data in the literature, the cost effectiveness of ATL compares favorably with that of other health technologies. Prospective multicenter studies of regional-cost and practice variations; long-term probabilities of year-to-year transitions between seizure outcome states and their effects on quality of life (QOL), and the effect of nonsurgical treatments on seizure control and QOL are needed to provide the critical data to confirm and constrain these estimates.
医疗保健提供者对高成本医疗技术的价值审查日益严格。为确保资源有效分配，需要了解高科技癫痫治疗的成本和结果。
采用决策分析来评估前颞叶切除术（ATL）与难治性癫痫的标准药物治疗相比的成本效益。将美国纽约罗切斯特的本地成本数据应用于一个假设患者队列的终身贴现成本及评估、ATL和随访结果模型。
基础病例分析得出的边际成本效益比（MECR）为每质量调整生命年（QALY）15581美元。广泛的敏感性分析确定了极端情况，即ATL评估占主导地位（更有效且成本更低），或者可能被认为不值得成本（MCER > 50000美元/QALY）。
即使考虑到许多模型参数的不确定性，ATL成本效益的估计仍在普遍可接受的范围内。根据文献中的现有数据假设，ATL的成本效益与其他医疗技术相比具有优势。需要进行关于区域成本和实践差异的前瞻性多中心研究；癫痫发作结果状态逐年转变的长期概率及其对生活质量（QOL）的影响，以及非手术治疗对癫痫控制和QOL的影响，以提供关键数据来证实和限制这些估计。
