Decision-Making for Treating Intractable Epilepsy:Comparison of Surgery,Vagus Nerve Stimulation, and Drug Therapy

• Main Authors: Chou Su-Lin, 周淑鈴
• Other Authors: Liou Horng-Huei
• Format: Others
• Language: en_US
• Published: 2002
• Online Access: http://ndltd.ncl.edu.tw/handle/23044237968344117697

碩士 === 國立臺灣大學 === 流行病學研究所 === 90 === Background: Treatment for patients with intractable epilepsy include new antiepileptic drugs (AEDs), vagus nerve stimulation (VNS), and surgery. Few studies made comparisons of these three treatments from the aspects of efficacy and cost taking quality of life into account. Objectives: The present thesis aimed to assess the cost and effectiveness of lamotrigine, topiramate, VNS and surgery as compared with the conventional AEDs. Methods: Empirical data on lamotrigine cohort is used to identify significant correlates associated with the decrease of frequency seizure. The systematic review of articles related to lamotrigine, topirmate, VNS, and surgery is conducted to assess the heterogeneity across studies. The decision Markov models are proposed to estimate the cost and the efficacy adjusted by quality of life. The GEE model and random-effect model are proposed to take correlated data of recurrent episodes into account. Meta-analysis is performed to assess the heterogeneity and adjusted odds ratio. The incremental cost-utility ratios are calculated for surgery, VNS, topirmate and lamotrigine as compared with conventional AEDs. Findings: Only the frequency of seizure in the baseline assessment is statistically significantly associated with the prognosis of treatment by lamotrigine. The results of meta-analysis find the efficacy of treatment in reducing episode are 2.71 (95% CI:1.44-5.08) for lamotrigine, 5.38 (95% CI:3.33-8.69) for topirmate, and 2.05 (95% CI:1.16-3.62) for vagus nerve stimulation. In the three state Markov model, the incremental cost-utility ratios for lamotrigine, topiramate, VNS and surgery against traditional drugs are US$ 1,628, US$ 2,768, US$ 5,691, and US$ 14,228 per utility-adjusted months. The VNS is dominated by topiramate. In the five- state Markov model, the incremental cost-utility ratios for lamotrigine, topiramate, VNS and surgery against traditional drugs are US$ 1,964, US$ 3,121, US$ 5,952, and US$ 15,066 per utility-adjusted months. The VNS is dominated by topiramate. Conclusions: In conclusion, the current thesis elucidates a constellation of prognostic factors associated with the administration of lamotrigine. A meta-analysis of systematic review of lamotrigine, topirmate, vagus nerve stimulation and surgery is performed to estimate the efficacy of each treatment in reducing seizures. The Markov models integrated by these estimates are further developed to simulate the effectiveness of each treatment. Cost-utility analysis is performed to assess an optimal decision for treating intractable epilepsy.