High Value Epilepsy Care in the United States: Predictors of Increased Costs and Complications from the National Inpatient Sample Database 2016-2019

Introduction For patients with medically refractory epilepsy newer minimally invasive techniques such as Laser Interstitial Thermal Therapy (LITT) have been developed in recent years. This study aims to characterize trends in the utilization of surgical resection versus LITT to treat medically refractory epilepsy, characterize complications, and understand the cost of this innovative technique to the public. Methods The National Inpatient Sample (NIS) database was queried from 2016 to 2019 for all patients admitted with a diagnosis of medically refractory epilepsy. Patient demographics, hospital length of stay, complications, and costs were tabulated for all patients who underwent LITT or surgical resection within these cohorts. Results A total of 6,019 patients were included, 223 underwent LITT procedures while 5,796 underwent resection. Significant predictors of increased patient charges for both cohorts included diabetes (OR 1.7, CI 1.44-2.19), infection (OR 5.12, CI 2.73-9.58), and hemorrhage (OR 2.95, CI 2.04-4.12). Procedures performed at non-teaching hospitals had 1.54 greater odds (CI 1.02-2.33) of resulting in a complication compared to teaching hospitals. Insurance status did significantly differ (p=0.001) between those receiving LITT (23.3% Medicare; 25.6% Medicaid; 44.4% Private insurance; 6.7 Other) and those undergoing resection (35.3% Medicare; 22.5% Medicaid; 34.7% Private Insurance; 7.5% other). When adjusting for patient demographics, LITT patients had shorter length of stay (2.3 vs 8.9 days, p < 0.001), lower complication rate (1.9% vs 3.1%, p=0.385), and lower mean hospital ($139,412.79 vs $233,120.99, p < 0.001) and patient ($55,394.34 vs $37,756.66, p < 0.001) costs. Conclusion The present study highlights LITT’s advantages through its association with lower costs and shorter length of stay. The present study also highlights the associated predictors of LITT vs resection, such as that most LITT cases happen at academic centers for patients with private insurance. As the adoption of LITT continues, more data will become available to further understand these issues.