Analytical approach:
A decision analytic tree model was used to estimate the cost-effectiveness of surgery relative to medical treatment of paediatric epilepsy. The time horizon of the study was one year following the surgical eligibility decision date. The authors did not explicitly report the perspective.
Effectiveness data:
Effectiveness data were derived from a cohort of children under 18 years with epilepsy intractable to medication identified from a magnetoencephalography database. Fifteen children who had undergone respective epilepsy surgery were selected randomly and recruited retrospectively. Fifteen children who were evaluated for epilepsy surgery during the same period and received medical treatment only were identified, selected randomly, and recruited. The main effectiveness estimate used in the model was percentage seizure reduction at one-year follow-up. This estimate was obtained by review of patient charts for each patient included in the study.
Monetary benefit and utility valuations:
None.
Measure of benefit:
The measure of benefit was percentage seizure reduction at one-year follow-up.
Cost data:
Direct costs included in the analysis were in-patient care (nursing, professional services, diagnostic imaging, laboratory, pharmacy, physician fees, and other in-patient costs), out-patient care (visits to neurology, neurosurgery, psychiatric and emergency departments, and diagnostic tests) and medications. In-patient and out-patient hospital costs were obtained from the hospital’s finance department. All medication costs included initial drug price, mark-up, and pharmacist and dispensing fees. All costs were collected for the period April 2007 to September 2009. All costs were reported in Canadian dollars (CAD).
Analysis of uncertainty:
A series of one-way sensitivity analyses was undertaken to assess the impact of uncertainty around key model inputs. A probabilistic sensitivity analysis was undertaken to obtain 95% confidence intervals for costs and seizure reduction and create an incremental cost-effectiveness scatter plot.