Cost-benefit of vagus nerve stimulation for refractory epilepsy

Purpose: Vagus nerve stimulation (VNS) is an established treatment for pati ents with medically refractory epilepsy who are unsuitable candidates for c onventional epilepsy surgery. VNS requires an initial financial investment but apart from our own previous study there are no reports on cost-benefit published to date. The purpose of this paper is to assess prospectively the cost-benefit ratio of VNS in a series of patients with long term follow-up . Methods: Our experience with VNS comprises 25 patients of whom 20 with suff icient follow-up will be further discussed These 20 patients have a mean po st-implantation follow-up of 26 months (range : 6-50 months). Mean age was 30 years (range: 12-45 years); mean duration of epilepsy 17 years (range : 5-35 years). We prospectively assessed seizure frequeny: prescribed AEDs, n umber of hospital admission days and side effects and calculated the epilep sy related direct medical cost and compared this with pre-implantation data . Results: Mean seizure frequency decreased from 14 seizures/month (range. 2- 40) to 9 seizules/month (range : 0-30) (p = 0.0003). The mean yearly epilep sy-related direct medical costs per patient dropped from 6,682 USD (range : 829-21,888 USD) to 3,635 USD (range: 684-12,486 USD) (p = 0.0046). The mea n number of hospital admission days was reduced from 16 days/year (range : 0-60) to 4 days/year (range : 0-30) (p = 0.0029). Conclusion : VNS is an efficacious and cost-beneficial treatment for refrac tory partial seizures.