• Iwen Pan, Melissa A LoPresti, Dave F Clarke, and Sandi Lam.
• Department of Health Services Research, Division of Cancer Prevention and Population Sciences, Houston, Texas.
• Neurosurgery. 2020 Dec 15; 88 (1): E73-E82.

BackgroundPediatric refractory epilepsy affects quality of life, clinical disability, and healthcare costs for patients and families.ObjectiveTo show the impact of surgical treatment for pediatric epilepsy on healthcare utilization compared to medically treated pediatric epilepsy over 5 yr.MethodsThe Pediatric Health Information System database was used to conduct a cohort study using 5 published algorithms. Refractory epilepsy patients treated with antiepileptic medications (AEDs) only or AEDs plus epilepsy surgery between 1/1/2008 and 12/31/2014 were included. Healthcare utilization following the index date at 2 and 5 yr including inpatient, emergency department (ED), and all epilepsy-related visits were evaluated. The propensity scores (PS) method was used to match surgically and medically treated patients. PS. SAS® 9.4 and Stata 14.0 were used for data management and statistical analysis.ResultsA total of 2106 (17.1%) and 10186 (82.9%) were surgically and medically treated. A total of 4050 matched cases, 2025 per each treated group, were included. Compared to medically treated patients, utilization was reduced in the surgical group: at 2 and 5 yr postindex date, there was a reduction of 36% to 37% of inpatient visits and 47% to 50% of ED visits. The total number (inpatient, ED, ambulatory visits) of epilepsy-associated visits were reduced by 39% to 43% in the surgical group compared to the medically treated group. In those who had surgery, the average reduction in AEDs was 16% at 2 and 5 yr after treatment.ConclusionPatients with refractory epilepsy treated with surgery had significant reductions in healthcare utilization compared with patients treated only with medications.Copyright © 2020 by the Congress of Neurological Surgeons.

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