Health Technology Assessment report on the presurgical evaluation and surgical treatment of drug-resistant epilepsy

Carlo Efisio Marras, Maria Paola Canevini, Gabriella Colicchio, Renzo Guerrini, Guido Rubboli, Massimo Scerrati, Roberto Spreafico, Laura Tassi, Giorgio Lorusso, Paolo Tinuper

Research output: Contribution to journalArticlepeer-review


Purpose: Epilepsy is a neurologic disorder with major social impact. Surgery is a valuable option n patients who are not responding to antiepileptic drugs. The literature reports demonstrate that a proportion ranging from 40 to 100% of patients with epilepsy achieve seizure remission after surgery. A presurgical evaluation (clinical and instrumental) must be performed in all patients with drug-resistant epilepsy to assess their suitability or surgical intervention. Health Technology Assessment (HTA) represents a modern appoach to the analysis of technologies used for health care. HTA could be considered a bridge between science that produces evidence and the decisions that can be taken on the basis of that evidence at different levels of the health care system. The aim of this study is the HTA of epilepsy urgery including clinical, ethical, social, and economic features. Methods: The present study includes an analysis of he diagnostic and surgical workup performed at he Italian centers for the diagnosis and treatment of drug-resistant epilepsy (DRE). The study ncludes the following issues: (1) social, ethical mpact, and costs of the disease; (2) clinical results, efficacy, and safety of surgery; (3) ethics and quality of life after surgery; and (4) economic impact and productivity regained after surgery. The cost of managing a patient with DRE included in the presurgical study was estimated by the bottom-up microcosting technique that starts from a detailed collection of data on consumption of resources and full costing. The phases analyzed were (1) noninvasive diagnostic workup; (2) neurosurgical intervention; and (3) follow-up. Key Findings: The literature reports indicate epilepsy surgery as an effective treatment both on clinical results and on ethical, social, and quality of life aspects. The workup including the noninvasive presurgical study followed by surgery has a total cost of €20,827. Management of short-term follow-up increases the overhead to €22,291 at the first year, and then to €23,571 after 5 years. According to the estimates made in this survey, funding based on diagnosis-related group (DRG) tariff for the noninvasive diagnostic stage involving hospital admission is not remunerative in Italy either at regional or national levels. Effectively the difference between full cost and DRG has a delta of €3,402 and €2,537 respectively. The total cost of the presurgical, surgical, and follow-up evaluation is not remunerative for €10,554 (national data). Significance: Economic surveys in Italy have shown that surgery for DREis anadvantageous treatment from the standpoint of third-party payers and is cost-effective for society. DRE presurgical evaluation and surgery are not remunerative either at regional or national levels.Wiley Periodicals, Inc.

Original languageEnglish
Pages (from-to)49-58
Number of pages10
Issue numberSUPPL.7
Publication statusPublished - Oct 2013


  • Drug-resistant epilepsy
  • Epilepsy costs
  • Epilepsy surgery
  • Health Technology Assessment

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Medicine(all)


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