PURPOSE: More than 20% of @entity302 @entity1 have refractory @entity410 . Treatment options for these @entity1 include continued polytherapy with/without novel @entity734 ( @entity734 ), @entity302 surgery (ES), or vagus nerve stimulation (VNS). The purpose of this study was prospectively to compare @entity302 -related direct medical costs (ERDMCs) incurred by these different treatment modalities. METHODS: Eighty-four @entity1 underwent a complete presurgical evaluation protocol at our institution. As a result, 24 (29%) @entity1 were treated with continued AED polytherapy only; 35 (40%) underwent ES; and 25 (30%) had VNS. In each @entity1 , annual costs in the 2 years preceding the therapeutic decision (ERDMC-pre) and during the follow-up afterward (ERDMC-post) were prospectively calculated. Furthermore, frequency of complex partial @entity410 with/without secondary generalization (CPS+/-SG), dosage and number of @entity734 , number of hospital admission days, clinic visits, and laboratory tests before and after the therapeutic decision also were prospectively assessed. ERDMC-pre and ERDMC-post were compared in and among the three treatment groups. RESULTS: In @entity1 conservatively treated with @entity734 , mean frequency of CPSs decreased from 12 per month to nine per month, whereas mean ERDMCs decreased from  2,525 U.S. to  2,421 U.S. In surgical @entity1 , mean @entity410 frequency decreased from six to fewer than one per month; mean ERDMCs per year decreased from  1,465 U.S. preoperatively to  1,186 U.S. postoperatively. In the VNS group, mean @entity410 frequency decreased from 21 per month to seven per month. ERDMCs in this subgroup decreased from  4,826 U.S. to  2,496 U.S. Mean @entity410 frequency changes were significant when conservatively treated @entity1 were compared with surgically treated and VNS @entity1 groups (chi2 test, p<0.001 and p=0.0019, respectively). ERDMC changes in conservatively treated @entity1 also were statistically significant when compared with surgically treated and VNS @entity1 (chi2 test, p=0.0007 and p=0.0036, respectively). No statistically significant differences were found in ERDMC changes between the surgical and VNS groups (chi2 test, p=0.387). CONCLUSIONS: Ongoing daily treatment of @entity1 who underwent resective surgery costs significantly less than conservative treatment. For @entity1 in whom resective surgery is not an option, ERDMC show a significant decrease in VNS-treated @entity1 compared with conservatively treated @entity1 .

Direct medical costs of XXXX incurred by three different treatment modalities: a prospective assessment.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity410 :: ('MESH:D012640', 'Disease') :: ['seizure', 'seizures'] @entity734 :: ('MESH:D019966', 'Disease') :: ['AEDs', 'antiepileptic drugs'] @entity302 :: ('MESH:D004827', 'Disease') :: ['epilepsy']
@entity302 :: (MESH:D004827,Disease) :: ['refractory epilepsy']
