{
  "abstract": "Background Resective epilepsy surgery is an established clinical intervention, but the cost-effectiveness at a national healthcare level is uncertain. This study evaluates the cost-effectiveness of resective epilepsy surgery compared with medical management in adults from national healthcare and personal social services perspectives.Methods A de novo decision analytic model was developed, comprising a 1-year decision tree and lifetime Markov model to evaluate lifetime costs and quality-adjusted life years (QALYs). Data were obtained from UK epilepsy surgery centres to evaluate the costs of preoperative assessment and the probability of undergoing resection after presurgical evaluation. Other clinical inputs were obtained from a systematic literature review. The main outcome of the analysis was the incremental cost-effectiveness ratio (ICER), with a cost-effectiveness threshold set at £20 000 cost per QALY gained.Results Data from 762 patients informed preoperative evaluation costs and the probability of undergoing epilepsy surgery after presurgical evaluation. The total lifetime cost of epilepsy treatment for people who had surgical treatment was £56 911, compared with £32 490 for medical management. Total QALYs per person for surgery were 15.91 and 13.76 for medical management. Resective epilepsy surgery was shown to be cost-effective with an ICER of £11 348 per QALY gained.Conclusions Our data inform and strengthen recommendations to prioritise referral of those with drug-refractory epilepsy to surgical centres. We provide a health economic rationale for the development and support of resective epilepsy surgery programmes across national healthcare systems.",
  "authors": [
    {
      "affiliations": [
        "National Institute for Health and Care Excellence, London, UK"
      ],
      "name": "Alexandra Bonnon"
    },
    {
      "affiliations": [
        "Department of Neurology, Northern Health NCHER, Epping, Victoria, Australia",
        "Department of Neurology, Austin Health, Heidelberg, Victoria, Australia"
      ],
      "name": "Paul Kopanidis"
    },
    {
      "affiliations": [
        "National Institute for Health and Care Excellence, London, UK"
      ],
      "name": "Sophia Kemmis-Betty"
    },
    {
      "affiliations": [
        "National Institute for Health and Care Excellence, London, UK"
      ],
      "name": "David Wonderling"
    },
    {
      "affiliations": [
        "Department of Epilepsy, UCL Queen Square Institute of Neurology, London, UK"
      ],
      "name": "Jane de Tisi"
    },
    {
      "affiliations": [
        "Department of Epilepsy, UCL Queen Square Institute of Neurology, London, UK",
        "Division of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK"
      ],
      "name": "Anna Miserocchi"
    },
    {
      "affiliations": [
        "Queen Elizabeth Hospital Birmingham, Birmingham, UK"
      ],
      "name": "Osama Sleem"
    },
    {
      "affiliations": [
        "Queen Elizabeth Hospital Birmingham, Birmingham, UK"
      ],
      "name": "Ilijana Sumonja Zisakis"
    },
    {
      "affiliations": [
        "Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK",
        "Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK"
      ],
      "name": "Janine Winterbottom"
    },
    {
      "affiliations": [
        "Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK"
      ],
      "name": "Besa Ziso"
    },
    {
      "affiliations": [
        "Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK",
        "Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK"
      ],
      "name": "Anthony G Marson"
    },
    {
      "affiliations": [
        "Department of Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK",
        "The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK"
      ],
      "name": "Paul Cooper"
    },
    {
      "affiliations": [
        "Department of Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK",
        "The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK"
      ],
      "name": "Rajiv Mohanraj"
    },
    {
      "affiliations": [
        "Department of Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK",
        "The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK"
      ],
      "name": "Vanisha Chauhan"
    },
    {
      "affiliations": [
        "Department of Neurology, North Bristol NHS Trust, Bristol, UK"
      ],
      "name": "Howard Faulkner"
    },
    {
      "affiliations": [
        "University Hospital Southampton NHS Foundation Trust, Southampton, UK"
      ],
      "name": "Sean J Slaght"
    },
    {
      "affiliations": [
        "Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK"
      ],
      "name": "Jane Adcock"
    },
    {
      "affiliations": [
        "Department of Neurology, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK",
        "The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK"
      ],
      "name": "Lucy Kinton"
    },
    {
      "affiliations": [
        "Department of Neurology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK"
      ],
      "name": "Ela Melisa Akay"
    },
    {
      "affiliations": [
        "Department of Neurology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK"
      ],
      "name": "Shan Ellawela"
    },
    {
      "affiliations": [
        "Department of Clinical Neurophysiology, King's College Hospital, London, UK"
      ],
      "name": "Nandini Mullatti"
    },
    {
      "affiliations": [
        "The Welsh Epilepsy Unit, Department of Neurology, University Hospital of Wales, Cardiff, UK"
      ],
      "name": "Khalid Hamandi"
    },
    {
      "affiliations": [
        "Department of Neurology, North Bristol NHS Trust, Bristol, UK"
      ],
      "name": "Katarzyna Sieradzan"
    },
    {
      "affiliations": [
        "Complex Epilepsy and Surgery Service, Neurosciences Centre, Queen Elizabeth Hospital, Birmingham, UK"
      ],
      "name": "Ramesh Chelvarajah"
    },
    {
      "affiliations": [
        "Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK"
      ],
      "name": "Judith Helen Cross"
    },
    {
      "affiliations": [
        "Department of Epilepsy, UCL Queen Square Institute of Neurology, London, UK"
      ],
      "name": "John Sidney Duncan"
    },
    {
      "affiliations": [
        "Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK",
        "Centre for Global Epilepsy Wolfson College, Wolfson College, Oxford, UK"
      ],
      "name": "Arjune Sen"
    }
  ],
  "title": "Is resective surgery cost-effective for adults with epilepsy? A cost-utility analysis in a publicly funded healthcare system",
  "uid": "4136837b-6a0d-5298-a696-13abac336d10"
}