Koszty i efekty kliniczne zabiegu operacyjnego na epilepsję w brazylijskim szpitalu publicznym: analiza ekonomiczna
Cost and clinical outcomes of epilepsy surgery in a Brazilian public hospital: a health economic evaluation
W skrócie
Badanie dotyczy kosztów i wyników operacji na epilepsję przeprowadzonej w brazylijskim szpitalu publicznym. Operacja kosztowała od około 4200 do 6800 dolarów amerykańskich w zależności od typu zabiegu, a większość pacjentów wykazała znaczną poprawę - zmniejszenie liczby napadów padaczkowych i zmniejszenie ilości leków. Wyniki pokazują, że zabiegi operacyjne na epilepsję są efektywne kosztowo i powinny być częściej stosowane w publicznych systemach opieki zdrowotnej w krajach o średnich dochodach.
Oryginalny abstract (angielski)
BACKGROUND: Epilepsy surgery is an established therapy for drug-resistant epilepsy, but it remains underused in Brazil. Assessing direct costs and outcomes is key for planning in low- and middle-income countries (LMICs). OBJECTIVE: To estimate surgery costs in a Brazilian public hospital and evaluate seizure and medication outcomes. METHODS: A retrospective economic evaluation was conducted among patients aged ≥ 16 years who underwent epilepsy surgery at a Brazilian tertiary public hospital between 2014 and 2019. A micro-costing (bottom-up) approach from the healthcare provider perspective was used to estimate actual resource consumption based on hospital administrative records. Costs were stratified by surgical technique, and clinical outcomes were assessed using seizure frequency, antiseizure medication use, and standardized Engel and International League Against Epilepsy (ILAE) classifications. RESULTS: Twenty patients were included, predominantly with temporal lobe epilepsy, and were mainly treated with resective procedures. Average direct costs varied according to the surgical technique, ranging from approximately US$ 4,200 for resective procedures to US$ 6,800 for disconnective surgeries. Hospital length of stay was the primary cost driver, followed by expenditures on materials and human resources. Overall, the observed costs were proportional to the clinical benefits, as most patients demonstrated favorable seizure control at 2-year follow-up, with consistent reductions in seizure frequency and antiseizure medication use. CONCLUSION: The current study presents a transparent hospital-based micro-costing approach to estimate the direct costs of epilepsy surgery in a tertiary public setting of a middle-income country. By focusing on actual resource consumption and standardized clinical outcomes, it supports the clinical effectiveness and economic plausibility of epilepsy surgery within the Brazilian Public Healthcare System and informs future economic evaluations in similar contexts.