Impact of vagus nerve stimulation on secondary care burden in children and adults with epilepsy: Review of routinely collected hospital data in England

Epilepsy Behav. 2015 Nov;52(Pt A):68-73. doi: 10.1016/j.yebeh.2015.08.026. Epub 2015 Sep 25.

Abstract

Purpose: We evaluated the long-term medical and economic benefits of vagus nerve stimulation (VNS) therapy for 704 adults and children with epilepsy. A pre-post analysis was conducted using Hospital Episode Statistics (HES) data (April 2008-July 2014). Seven hundred and four patients with epilepsy diagnoses (ICD-10 G40.x or G41.x), one or more procedures for vagus nerve stimulator implantation, and six or more months of available HES data pre- and post-VNS were selected. The pre-VNS period averaged 39.1 months. The post-VNS period extended from implantation to device removal, death, or study end (up to six years), with a mean duration of 36.4 months. Incidence rate ratios (IRRs) and cost differences (£2014) were estimated. Mean age was 28.3 years.

Results: Inpatient admissions decreased post-VNS compared with pre-VNS (adjusted IRR=0.81, P<0.001). Overall, outpatient consultations increased post-VNS compared with pre-VNS (adjusted IRR=1.34, P<0.001). However, outpatient consultations exhibited a decreasing trend in the post-VNS period (adjusted IRR=0.96, P<0.001), suggesting that much of the increased outpatient activity in the post-VNS period relates to follow-up management of the VNS device in the immediate period following implantation, with comparable outpatient resource burden at 36 months post-VNS. No significant changes in clinical events were observed; however, average epilepsy-related medical costs were lower post-VNS than pre-VNS (adjusted cost difference -£110 quarterly, P=0.001).

Conclusions: Vagus nerve stimulation is associated with increased outpatient resource utilization and decreased inpatient admissions, with a reduction in long-term epilepsy-related medical costs post-implantation.

Keywords: Cost savings; Costs; Economics; Outcomes; Resource utilization; Vagus nerve stimulation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Cohort Studies
  • Cost of Illness
  • Device Removal
  • Electrodes, Implanted
  • England
  • Epilepsy / complications
  • Epilepsy / economics
  • Epilepsy / therapy*
  • Female
  • Health Care Costs / statistics & numerical data
  • Health Resources / statistics & numerical data
  • Hospitalization / economics
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Outpatients
  • Retrospective Studies
  • Treatment Outcome
  • Vagus Nerve Stimulation / economics
  • Vagus Nerve Stimulation / methods*
  • Young Adult