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The added clinical and economic value of diagnostic testing for epilepsy surgery
The costs, benefits and risks associated with diagnostic imaging investigations for epilepsy surgery necessitate the identification of an optimal pathway in the pre-surgical workup. In order to assess the added value of additional investigations a full cost-effectiveness evaluation should be conduct...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier Science Publishers
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000270/ https://www.ncbi.nlm.nih.gov/pubmed/24630045 http://dx.doi.org/10.1016/j.eplepsyres.2014.02.002 |
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author | Hinde, Sebastian Soares, Marta Burch, Jane Marson, Anthony Woolacott, Nerys Palmer, Stephen |
author_facet | Hinde, Sebastian Soares, Marta Burch, Jane Marson, Anthony Woolacott, Nerys Palmer, Stephen |
author_sort | Hinde, Sebastian |
collection | PubMed |
description | The costs, benefits and risks associated with diagnostic imaging investigations for epilepsy surgery necessitate the identification of an optimal pathway in the pre-surgical workup. In order to assess the added value of additional investigations a full cost-effectiveness evaluation should be conducted, taking into account all of the life-time costs and benefits associated with undertaking additional investigations. This paper considers and applies the appropriate framework against which a full evaluation should be assessed. We conducted a systematic review to evaluate the progression of the literature through this framework, finding that only isolated elements of added value have been appropriately evaluated. The results from applying the full added value framework are also presented, identifying an optimal strategy for pre-surgical evaluation for temporal lobe epilepsy surgery. Our results suggest that additional FDG–PET and invasive EEG investigations after an initially discordant MRI and video-EEG appears cost-effective, and that the value of subsequent invasive-EEGs is closely linked to the maintenance of longer-term benefits after surgery. It is integral to the evaluation of imaging technologies in the work-up for epilepsy surgery that the impact of the use of these technologies on clinical decision-making, and on further treatment decisions, is considered fully when informing cost-effectiveness. |
format | Online Article Text |
id | pubmed-4000270 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Elsevier Science Publishers |
record_format | MEDLINE/PubMed |
spelling | pubmed-40002702014-05-01 The added clinical and economic value of diagnostic testing for epilepsy surgery Hinde, Sebastian Soares, Marta Burch, Jane Marson, Anthony Woolacott, Nerys Palmer, Stephen Epilepsy Res Article The costs, benefits and risks associated with diagnostic imaging investigations for epilepsy surgery necessitate the identification of an optimal pathway in the pre-surgical workup. In order to assess the added value of additional investigations a full cost-effectiveness evaluation should be conducted, taking into account all of the life-time costs and benefits associated with undertaking additional investigations. This paper considers and applies the appropriate framework against which a full evaluation should be assessed. We conducted a systematic review to evaluate the progression of the literature through this framework, finding that only isolated elements of added value have been appropriately evaluated. The results from applying the full added value framework are also presented, identifying an optimal strategy for pre-surgical evaluation for temporal lobe epilepsy surgery. Our results suggest that additional FDG–PET and invasive EEG investigations after an initially discordant MRI and video-EEG appears cost-effective, and that the value of subsequent invasive-EEGs is closely linked to the maintenance of longer-term benefits after surgery. It is integral to the evaluation of imaging technologies in the work-up for epilepsy surgery that the impact of the use of these technologies on clinical decision-making, and on further treatment decisions, is considered fully when informing cost-effectiveness. Elsevier Science Publishers 2014-05 /pmc/articles/PMC4000270/ /pubmed/24630045 http://dx.doi.org/10.1016/j.eplepsyres.2014.02.002 Text en © 2014 The Authors http://creativecommons.org/licenses/by/3.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/3.0/). |
spellingShingle | Article Hinde, Sebastian Soares, Marta Burch, Jane Marson, Anthony Woolacott, Nerys Palmer, Stephen The added clinical and economic value of diagnostic testing for epilepsy surgery |
title | The added clinical and economic value of diagnostic testing for epilepsy surgery |
title_full | The added clinical and economic value of diagnostic testing for epilepsy surgery |
title_fullStr | The added clinical and economic value of diagnostic testing for epilepsy surgery |
title_full_unstemmed | The added clinical and economic value of diagnostic testing for epilepsy surgery |
title_short | The added clinical and economic value of diagnostic testing for epilepsy surgery |
title_sort | added clinical and economic value of diagnostic testing for epilepsy surgery |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000270/ https://www.ncbi.nlm.nih.gov/pubmed/24630045 http://dx.doi.org/10.1016/j.eplepsyres.2014.02.002 |
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