Health economic analyses of epilepsy surgery

We review general health economics and evidence-based medicine concepts as they pertain to epilepsy. A brief analysis of cost of illness studies in epilepsy demonstrates substantial burden of illness, identifies important components (e.g., antiseizure medications, hospitalizations, indirect costs), and assesses factors associated with burden, such as seizure control. A systematic analysis of long-term, comparative economic evaluations in epilepsy shows that such studies are scarce, many are methodologically weak, and reporting of results is highly variable. Most studies focus on patients with temporal lobe epilepsy, few focus on children or on resource-poor countries, and none addresses the very young or very old. Despite methodological caveats, studies consistently demonstrate the costeffectiveness of epilepsy surgery, which is often more effective and cheaper than the medical treatment alternatives. We present recommendations for future economic analyses of epilepsy surgery.