Cost-Effectiveness Analysis Of Stereotaxic Eeg (SEEG) As A Preoperative Diagnostic Procedure In Epilepsy Surgery

OBJECTIVES: The aim of our study was to determine the health gain and the corresponding costs resulted from the introduction of stereotaxic EEG (SEEG) as a preoperative diagnostic procedure in epilepsy surgery for MRI negative refractory epilepsy patients. Furthermore, we analyzed the cost-effectiveness of the intervention compared to medical management as the standard of care in Hungary. METHODS: The incremental health gains and costs of SEEG were determined with a Markov model over a 45 years' time horizon. Transition probabilities and utilities have been derived from international literature. The intervention has not yet been financed by the National Healthcare Fund in Hungary, therefore the actual cost were determined from provider's perspective, based on the relevant units costs and resource use at the Department of Neurology and Department of Neurosurgery regarding the intervention. RESULTS: Based on the result of our model the total cost of the SEEG intervention is 10,540 thousand HUF which represents a 4,490 thousand HUF additional cost and 3.086 QALY gain in 45 years compare to the standard medical management. The calculated preliminary incremental cost-effectiveness ratio is 1,455 thousand HUF/QALY. CONCLUSIONS: Based on our preliminary results in the treatment of patients with MR negative refractory epilepsy the preoperative SEEG diagnostic procedure in Hungary was cost-effective compared to the medical management. Based on our result we suggest the SEEG to be introduced into the Hungarian reimbursement system as a new procedure.