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stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng217er13-lrg.png" alt="Cover of Evidence reviews for surgery: referral and surgical interventions" /></a></div><div class="bkr_bib"><h1 id="_NBK586314_"><span itemprop="name">Evidence reviews for surgery: referral and surgical interventions</span></h1><div class="subtitle">Epilepsies in children, young people and adults: diagnosis and management</div><p><b>Evidence review 13</b></p><p><i>NICE Guideline, No. 217</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2022 Apr</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-4513-9</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div></div><div class="bkr_clear"></div></div><div id="niceng217er13.s1"><h2 id="_niceng217er13_s1_">1. Resective epilepsy surgery</h2><div id="niceng217er13.s1.1"><h3>1.1. Introduction</h3><p>Epilepsy surgery refers to a neurosurgical procedure where the primary purpose is to improve seizure control. Epilepsy surgery may be a viable treatment option for some people with seizures. Presurgical investigations are extensive and multidisciplinary, as is the post-surgical follow-up of people who undergo this procedure. ‘Success’ may be determined on an individual basis; freedom from seizures may be a goal for some; for others surgery may be offered as a palliative procedure. This chapter examines:
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<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>i)</dt><dd><p class="no_top_margin">the evidence for the clinical and cost-effectiveness of different criteria for referral to surgery</p></dd></dl><dl class="bkr_refwrap"><dt>ii)</dt><dd><p class="no_top_margin">the evidence for the clinical and cost-effectiveness of resective epilepsy surgery (please see separate review for vagal nerve stimulation).</p></dd></dl></dl></p></div><div id="niceng217er13.s1.2"><h3>1.2. Review question: What is the clinical and cost-effectiveness of different criteria for referral to epilepsy surgical services?</h3><div id="niceng217er13.s1.2.1"><h4>1.2.1. Summary of the protocol</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er13tab1"><a href="/books/NBK586314/table/niceng217er13.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er13tab1" rid-ob="figobniceng217er13tab1"><img class="small-thumb" src="/books/NBK586314/table/niceng217er13.tab1/?report=thumb" src-large="/books/NBK586314/table/niceng217er13.tab1/?report=previmg" alt="Table 1. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="niceng217er13.tab1"><a href="/books/NBK586314/table/niceng217er13.tab1/?report=objectonly" target="object" rid-ob="figobniceng217er13tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div><div id="niceng217er13.s1.2.2"><h4>1.2.2. Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng217er13.appa">appendix A</a> and the <a href="/books/NBK586314/bin/niceng217er13_bm1.pdf">methods</a> document. Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng217er13.s1.2.3"><h4>1.2.3. Effectiveness evidence</h4><p>No relevant studies were found</p><div id="niceng217er13.s1.2.3.1"><h5>1.2.3.1. Included studies</h5><p>No relevant clinical studies comparing different referral criteria in terms of the pre-determined outcome were identified.</p><p>See also the study selection flow chart in <a href="#niceng217er13.appc">Appendix C</a>, study evidence tables in <a href="#niceng217er13.apph">Appendix H</a>, forest plots in 0 and GRADE tables in <a href="#niceng217er13.appj">Appendix J</a>.</p></div><div id="niceng217er13.s1.2.3.2"><h5>1.2.3.2. Excluded studies</h5><p>See the excluded studies list in <a href="#niceng217er13.appg">Appendix G</a>.</p></div></div><div id="niceng217er13.s1.2.4"><h4>1.2.4. Economic evidence</h4><div id="niceng217er13.s1.2.4.1"><h5>1.2.4.1. Included studies</h5><p>No health economic studies were included.</p></div><div id="niceng217er13.s1.2.4.2"><h5>1.2.4.2. Excluded studies</h5><p>No relevant health economic studies were excluded due to assessment of limited applicability or methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#niceng217er13.appd">D</a>.</p></div></div><div id="niceng217er13.s1.2.5"><h4>1.2.5. Economic model</h4><p>This area was not prioritised for a new cost-effectiveness analysis.</p></div><div id="niceng217er13.s1.2.6"><h4>1.2.6. Unit costs</h4><p>Relevant unit costs are provided below to aid consideration of cost effectiveness.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er13tab2"><a href="/books/NBK586314/table/niceng217er13.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er13tab2" rid-ob="figobniceng217er13tab2"><img class="small-thumb" src="/books/NBK586314/table/niceng217er13.tab2/?report=thumb" src-large="/books/NBK586314/table/niceng217er13.tab2/?report=previmg" alt="Table 2. Costs of pre-surgical evaluation tests." /></a><div class="icnblk_cntnt"><h4 id="niceng217er13.tab2"><a href="/books/NBK586314/table/niceng217er13.tab2/?report=objectonly" target="object" rid-ob="figobniceng217er13tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Costs of pre-surgical evaluation tests. </p></div></div><p>Costs for epilepsy surgery were found by looking up OPCS codes for the epilepsy surgery types listed on the review protocol. These were then linked to the HRG codes using the HRG4 reference costs grouper ‘code to group’ spreadsheet. A single OPCS code can be linked to several HRG codes depending on whether certain ‘flags’ are raised that changes the complexity of the procedure. All the codes HRG codes identified are listed below for an illustration of the costs.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er13tab3"><a href="/books/NBK586314/table/niceng217er13.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er13tab3" rid-ob="figobniceng217er13tab3"><img class="small-thumb" src="/books/NBK586314/table/niceng217er13.tab3/?report=thumb" src-large="/books/NBK586314/table/niceng217er13.tab3/?report=previmg" alt="Table 3. Costs of surgery." /></a><div class="icnblk_cntnt"><h4 id="niceng217er13.tab3"><a href="/books/NBK586314/table/niceng217er13.tab3/?report=objectonly" target="object" rid-ob="figobniceng217er13tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Costs of surgery. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er13tab4"><a href="/books/NBK586314/table/niceng217er13.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er13tab4" rid-ob="figobniceng217er13tab4"><img class="small-thumb" src="/books/NBK586314/table/niceng217er13.tab4/?report=thumb" src-large="/books/NBK586314/table/niceng217er13.tab4/?report=previmg" alt="Table 4. Anti-seizure medication costs." /></a><div class="icnblk_cntnt"><h4 id="niceng217er13.tab4"><a href="/books/NBK586314/table/niceng217er13.tab4/?report=objectonly" target="object" rid-ob="figobniceng217er13tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Anti-seizure medication costs. </p></div></div></div><div id="niceng217er13.s1.2.7"><h4>1.2.7. The committee’s discussion and interpretation of the evidence</h4><p>No evidence was found examining the use of different criteria for referral or surgery. The committee, therefore, agreed to use the clinical and health economic evidence on the effectiveness of surgical procedures to inform their recommendations regarding referral. The evidence and discussion are in <a href="#niceng217er13.s1.3">section 1.3</a>.</p></div></div><div id="niceng217er13.s1.3"><h3>1.3. Review question: What is the effectiveness of resective surgery in epilepsy?</h3><div id="niceng217er13.s1.3.1"><h4>1.3.1. Summary of the protocol</h4><p>For full details see the review protocol in <a href="#niceng217er13.appa">Appendix A</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er13tab5"><a href="/books/NBK586314/table/niceng217er13.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er13tab5" rid-ob="figobniceng217er13tab5"><img class="small-thumb" src="/books/NBK586314/table/niceng217er13.tab5/?report=thumb" src-large="/books/NBK586314/table/niceng217er13.tab5/?report=previmg" alt="Table 5. PICO characteristics of review question." /></a><div class="icnblk_cntnt"><h4 id="niceng217er13.tab5"><a href="/books/NBK586314/table/niceng217er13.tab5/?report=objectonly" target="object" rid-ob="figobniceng217er13tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of review question. </p></div></div></div><div id="niceng217er13.s1.3.2"><h4>1.3.2. Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng217er13.appa">appendix A</a> and the <a href="/books/NBK586314/bin/niceng217er13_bm1.pdf">methods</a> document.</p><p>For the outcome of seizure freedom, hazard ratios (HRs) for the first seizure were either not available from the papers or poorly reported. HRs were therefore calculated from Kaplan Meier survival graphs and other data provided in the studies: life tables were constructed by the reviewer, and HRs for the first seizure were calculated using excel.</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng217er13.s1.3.3"><h4>1.3.3. Effectiveness evidence</h4><div id="niceng217er13.s1.3.3.1"><h5>1.3.3.1. Included studies</h5><p>A search was conducted for randomised trials comparing surgical interventions to usual care or waitlist control.</p><p>Three randomised control trials (RCTs) comprising four papers were included in the review.<a class="bibr" href="#niceng217er13.ref18" rid="niceng217er13.ref18"><sup>18</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er13.ref19" rid="niceng217er13.ref19"><sup>19</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er13.ref21" rid="niceng217er13.ref21"><sup>21</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er13.ref83" rid="niceng217er13.ref83"><sup>83</sup></a>, two RCTs were conducted in children and one in adults. These are summarised in <a class="figpopup" href="/books/NBK586314/table/niceng217er13.tab2/?report=objectonly" target="object" rid-figpopup="figniceng217er13tab2" rid-ob="figobniceng217er13tab2">Table 2</a>. Evidence from these studies is summarised in the clinical evidence summary below (<a class="figpopup" href="/books/NBK586314/table/niceng217er13.tab3/?report=objectonly" target="object" rid-figpopup="figniceng217er13tab3" rid-ob="figobniceng217er13tab3">Table 3</a>).</p><p>See also the study selection flow chart in <a href="#niceng217er13.appc">Appendix C</a>, study evidence tables in <a href="#niceng217er13.apph">Appendix H</a>, forest plots in 0 and GRADE tables in <a href="#niceng217er13.appj">Appendix J</a>.</p></div><div id="niceng217er13.s1.3.3.2"><h5>1.3.3.2. Excluded studies</h5><p>See the excluded studies list in <a href="#niceng217er13.appg">Appendix G</a>.</p></div></div><div id="niceng217er13.s1.3.4"><h4>1.3.4. Summary of studies included in the effectiveness evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er13tab6"><a href="/books/NBK586314/table/niceng217er13.tab6/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er13tab6" rid-ob="figobniceng217er13tab6"><img class="small-thumb" src="/books/NBK586314/table/niceng217er13.tab6/?report=thumb" src-large="/books/NBK586314/table/niceng217er13.tab6/?report=previmg" alt="Table 6. Summary of studies included in the evidence review." /></a><div class="icnblk_cntnt"><h4 id="niceng217er13.tab6"><a href="/books/NBK586314/table/niceng217er13.tab6/?report=objectonly" target="object" rid-ob="figobniceng217er13tab6">Table 6</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review. </p></div></div><p>See <a href="#niceng217er13.apph">Appendix H</a> for full evidence tables.</p></div><div id="niceng217er13.s1.3.5"><h4>1.3.5. Summary of the effectiveness evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er13tab7"><a href="/books/NBK586314/table/niceng217er13.tab7/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er13tab7" rid-ob="figobniceng217er13tab7"><img class="small-thumb" src="/books/NBK586314/table/niceng217er13.tab7/?report=thumb" src-large="/books/NBK586314/table/niceng217er13.tab7/?report=previmg" alt="Table 7. Clinical evidence summary: Surgery versus medical/ waitlist-control." /></a><div class="icnblk_cntnt"><h4 id="niceng217er13.tab7"><a href="/books/NBK586314/table/niceng217er13.tab7/?report=objectonly" target="object" rid-ob="figobniceng217er13tab7">Table 7</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: Surgery versus medical/ waitlist-control. </p></div></div><p>See <a href="#niceng217er13.appj">Appendix J</a> for full GRADE tables.</p></div><div id="niceng217er13.s1.3.6"><h4>1.3.6. Economic evidence</h4><div id="niceng217er13.s1.3.6.1"><h5>1.3.6.1. Included studies</h5><p>Two health economic studies in adults, with the relevant comparison, were included in this review.<a class="bibr" href="#niceng217er13.ref10" rid="niceng217er13.ref10"><sup>10</sup></a><sup>,</sup><a class="bibr" href="#niceng217er13.ref23" rid="niceng217er13.ref23"><sup>23</sup></a><sup>,</sup><a class="bibr" href="#niceng217er13.ref29" rid="niceng217er13.ref29"><sup>29</sup></a></p><p>These studies both focused on the cost-effectiveness of diagnostic strategies to localise the epileptogenic zone prior to surgery rather than the cost-effectiveness of surgery itself. This pre-surgery assessment is costly. Not everyone who has these tests will then go on to have the surgery, but these costs need to be considered as part of the surgery because they will determine who eventually receives surgery and the overall cost per surgery candidate (e.g., if you have to test 10 people to find one candidate or alternatively test 100 to find one candidate then this affects the costs per surgery). Additionally, the benefit of a diagnostic test comes from the intervention that can follow, rather than the test itself, and therefore as some people will receive surgery in the diagnostic strategy arms (dependent on the results of the test), then the outcomes of those strategies are still relevant for this surgery question. It is possible to compare the cost-effectiveness of surgery with no surgery from such studies, as long as they have a medical management arm and the diagnostic pathway is relevant.</p><p>These data are summarised in the health economic evidence profiles below (<a class="figpopup" href="/books/NBK586314/table/niceng217er13.tab8/?report=objectonly" target="object" rid-figpopup="figniceng217er13tab8" rid-ob="figobniceng217er13tab8">Table 8</a> and <a class="figpopup" href="/books/NBK586314/table/niceng217er13.tab9/?report=objectonly" target="object" rid-figpopup="figniceng217er13tab9" rid-ob="figobniceng217er13tab9">Table 9</a>) and the health economic evidence tables in <a href="#niceng217er13.appe">Appendix E</a>.</p></div></div><div id="niceng217er13.s1.3.7"><h4>1.3.7. Excluded studies</h4><p>Four economic studies<a class="bibr" href="#niceng217er13.ref9" rid="niceng217er13.ref9"><sup>9</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er13.ref44" rid="niceng217er13.ref44"><sup>44</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er13.ref50" rid="niceng217er13.ref50"><sup>50</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er13.ref82" rid="niceng217er13.ref82"><sup>82</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er13.ref12" rid="niceng217er13.ref12"><sup>12</sup></a>relating to this review question were identified but were excluded due to methodological limitations and the availability of more applicable evidence. These are listed in <a href="#niceng217er13.appg">Appendix G</a>, with reasons for exclusion given.</p><p>See also the health economic study selection flow chart in <a href="#niceng217er13.appd">Appendix D</a>.</p></div><div id="niceng217er13.s1.3.8"><h4>1.3.8. Summary of included economic evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er13tab8"><a href="/books/NBK586314/table/niceng217er13.tab8/?report=objectonly" target="object" title="Table 8" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er13tab8" rid-ob="figobniceng217er13tab8"><img class="small-thumb" src="/books/NBK586314/table/niceng217er13.tab8/?report=thumb" src-large="/books/NBK586314/table/niceng217er13.tab8/?report=previmg" alt="Table 8. Health economic evidence profile: Testing strategies following discordant EEG and MRI findings versus medical management." /></a><div class="icnblk_cntnt"><h4 id="niceng217er13.tab8"><a href="/books/NBK586314/table/niceng217er13.tab8/?report=objectonly" target="object" rid-ob="figobniceng217er13tab8">Table 8</a></h4><p class="float-caption no_bottom_margin">Health economic evidence profile: Testing strategies following discordant EEG and MRI findings versus medical management. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er13tab9"><a href="/books/NBK586314/table/niceng217er13.tab9/?report=objectonly" target="object" title="Table 9" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er13tab9" rid-ob="figobniceng217er13tab9"><img class="small-thumb" src="/books/NBK586314/table/niceng217er13.tab9/?report=thumb" src-large="/books/NBK586314/table/niceng217er13.tab9/?report=previmg" alt="Table 9. Health economic evidence profile: Intracranial EEG (subdural grid electrodes) versus iEEG (stereoelectroencephalography) versus medical management." /></a><div class="icnblk_cntnt"><h4 id="niceng217er13.tab9"><a href="/books/NBK586314/table/niceng217er13.tab9/?report=objectonly" target="object" rid-ob="figobniceng217er13tab9">Table 9</a></h4><p class="float-caption no_bottom_margin">Health economic evidence profile: Intracranial EEG (subdural grid electrodes) versus iEEG (stereoelectroencephalography) versus medical management. </p></div></div></div><div id="niceng217er13.s1.3.9"><h4>1.3.9. Economic model</h4><p>An original cost-utility analysis was developed, assessing the cost-effectiveness of resective epilepsy surgery in adults with drug refectory epilepsy. Original health economic modelling was also planned to model the cost-effectiveness of resective epilepsy surgery in children, but insufficient data were available to model for this population. Full details of the health economic analysis can be found in the Economic analysis report.</p><p>The committee identified this as a high priority area as they thought that currently, there could be a reluctance to refer people for resective epilepsy surgery. The committee wanted to evaluate the benefits of resective epilepsy in terms of improved seizure freedom and long-term cost savings.</p><div id="niceng217er13.s1.3.9.1"><h5>Model structure</h5><p>The following comparators were included in the analysis:
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<ol><li class="half_rhythm"><div>Resective epilepsy surgery</div></li><li class="half_rhythm"><div>Medical management</div></li></ol></p><p>The population of the analysis was adults with drug refractory epilepsy.</p><p>A two-part model was developed, which included a decision tree to model post-procedural outcomes (over 1 year) followed by a Markov model for the estimation of quality-adjusted life-years and costs over the lifetime of the patient. The decision tree structure can be found in <a class="figpopup" href="/books/NBK586314/figure/niceng217er13.fig1/?report=objectonly" target="object" rid-figpopup="figniceng217er13fig1" rid-ob="figobniceng217er13fig1">Figure 1</a>, and long-term Markov model structure can be found in <a class="figpopup" href="/books/NBK586314/figure/niceng217er13.fig2/?report=objectonly" target="object" rid-figpopup="figniceng217er13fig2" rid-ob="figobniceng217er13fig2">Figure 2</a>.</p><div class="iconblock whole_rhythm clearfix ten_col fig" id="figniceng217er13fig1" co-legend-rid="figlgndniceng217er13fig1"><a href="/books/NBK586314/figure/niceng217er13.fig1/?report=objectonly" target="object" title="Figure 1" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er13fig1" rid-ob="figobniceng217er13fig1"><img class="small-thumb" src="/books/NBK586314/bin/niceng217er13f1.gif" src-large="/books/NBK586314/bin/niceng217er13f1.jpg" alt="Figure 1. Decision tree." /></a><div class="icnblk_cntnt" id="figlgndniceng217er13fig1"><h4 id="niceng217er13.fig1"><a href="/books/NBK586314/figure/niceng217er13.fig1/?report=objectonly" target="object" rid-ob="figobniceng217er13fig1">Figure 1</a></h4><p class="float-caption no_bottom_margin">Decision tree. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col fig" id="figniceng217er13fig2" co-legend-rid="figlgndniceng217er13fig2"><a href="/books/NBK586314/figure/niceng217er13.fig2/?report=objectonly" target="object" title="Figure 2" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er13fig2" rid-ob="figobniceng217er13fig2"><img class="small-thumb" src="/books/NBK586314/bin/niceng217er13f2.gif" src-large="/books/NBK586314/bin/niceng217er13f2.jpg" alt="Figure 2. Markov model." /></a><div class="icnblk_cntnt" id="figlgndniceng217er13fig2"><h4 id="niceng217er13.fig2"><a href="/books/NBK586314/figure/niceng217er13.fig2/?report=objectonly" target="object" rid-ob="figobniceng217er13fig2">Figure 2</a></h4><p class="float-caption no_bottom_margin">Markov model. </p></div></div><p>The model base case analysis was built probabilistically to take account of the uncertainty around input parameter point estimates. A probability distribution was defined for each model input parameter. When the model was run, a value for each input was randomly selected simultaneously from its respective probability distribution; mean costs and mean QALYs were calculated using these values. The model was run repeatedly – 5,000 times - and results were summarised.</p></div><div id="niceng217er13.s1.3.9.2"><h5>Data inputs</h5><ul><li class="half_rhythm"><div>Seizure freedom at one year was taken from the two trials in adults in the guideline clinical review<a class="bibr" href="#niceng217er13.ref19" rid="niceng217er13.ref19"><sup>19</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er13.ref83" rid="niceng217er13.ref83"><sup>83</sup></a></div></li><li class="half_rhythm"><div>Longer-term outcomes from surgery were taken from de Tisi 2011<a class="bibr" href="#niceng217er13.ref16" rid="niceng217er13.ref16"><sup>16</sup></a></div></li><li class="half_rhythm"><div>Longer-term outcomes for medical management were taken from Callaghan 2011<a class="bibr" href="#niceng217er13.ref11" rid="niceng217er13.ref11"><sup>11</sup></a></div></li><li class="half_rhythm"><div>Standardised mortality ratios<a class="bibr" href="#niceng217er13.ref58" rid="niceng217er13.ref58"><sup>58</sup></a>
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<a class="bibr" href="#niceng217er13.ref67" rid="niceng217er13.ref67"><sup>67</sup></a>
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<a class="bibr" href="#niceng217er13.ref2" rid="niceng217er13.ref2"><sup>2</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er13.ref36" rid="niceng217er13.ref36"><sup>36</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er13.ref43" rid="niceng217er13.ref43"><sup>43</sup></a> were applied to national life tables for England<a class="bibr" href="#niceng217er13.ref46" rid="niceng217er13.ref46"><sup>46</sup></a>. These were differentiated by seizure-free and not seizure-free</div></li><li class="half_rhythm"><div>Utilities came from the SANAD study<a class="bibr" href="#niceng217er13.ref77" rid="niceng217er13.ref77"><sup>77</sup></a></div></li><li class="half_rhythm"><div>Some costs were included only in the surgery arm:
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<ul class="circle"><li class="half_rhythm"><div>The surgical procedure including hospital stay</div></li><li class="half_rhythm"><div>Preoperative assessment</div></li><li class="half_rhythm"><div>Treatment of long-term complications arising from surgery</div></li><li class="half_rhythm"><div>Re-operation</div></li></ul></div></li><li class="half_rhythm"><div>Other costs were attributed to both the surgery and medical management arms but were determined by whether the patient was in a state of seizure-freedom or disabling seizures:
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<ul class="circle"><li class="half_rhythm"><div>Anti-seizure medication</div></li><li class="half_rhythm"><div>GP and outpatient hospital visits</div></li><li class="half_rhythm"><div>Inpatient stays</div></li></ul></div></li><li class="half_rhythm"><div>The impact of surgical complications was based on expert and committee opinion. The risk of long-term complications was 4%. For patients that experienced a complication, there was a reduction in EQ-5D of 0.2, and an additional cost per year of £5,000 was applied over the lifetime.</div></li><li class="half_rhythm"><div>Reoperation was 4% based on committee opinion</div></li><li class="half_rhythm"><div>Resource use involved with preoperative assessment came from a bespoke survey of adult surgical centres (see <a class="figpopup" href="/books/NBK586314/table/niceng217er13.tab10/?report=objectonly" target="object" rid-figpopup="figniceng217er13tab10" rid-ob="figobniceng217er13tab10">Table 10</a>)</div></li><li class="half_rhythm"><div>The impact of seizure freedom on resource use was based on Jacoby 1998<a class="bibr" href="#niceng217er13.ref25" rid="niceng217er13.ref25"><sup>25</sup></a>, Wieser<a class="bibr" href="#niceng217er13.ref86" rid="niceng217er13.ref86"><sup>86</sup></a> and expert opinion</div></li><li class="half_rhythm"><div>The unit costs of surgery, tests, appointments, admissions, and drugs came from standard NHS sources<a class="bibr" href="#niceng217er13.ref42" rid="niceng217er13.ref42"><sup>42</sup></a>
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<a class="bibr" href="#niceng217er13.ref7" rid="niceng217er13.ref7"><sup>7</sup></a></div></li></ul></div><div id="niceng217er13.s1.3.9.3"><h5>Assessment for resective surgery survey</h5><p>A comprehensive survey was administered to participating adult epilepsy surgery centres to obtain the average number of tests for people undergoing assessment for resective epilepsy surgery. Ten surgical centres submitted data for a total of 762 people.</p><p>Overall, fourteen epilepsy surgical centres were contacted, resulting in a response rate of 71%. The committee was provided with a list of the participating surgical centres and concluded the data would provide a representative sample to obtain the resource use for preoperative assessment.</p><p>The mean number of tests are reported in <a class="figpopup" href="/books/NBK586314/table/niceng217er13.tab10/?report=objectonly" target="object" rid-figpopup="figniceng217er13tab10" rid-ob="figobniceng217er13tab10">Table 10</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er13tab10"><a href="/books/NBK586314/table/niceng217er13.tab10/?report=objectonly" target="object" title="Table 10" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er13tab10" rid-ob="figobniceng217er13tab10"><img class="small-thumb" src="/books/NBK586314/table/niceng217er13.tab10/?report=thumb" src-large="/books/NBK586314/table/niceng217er13.tab10/?report=previmg" alt="Table 10. Preoperative assessment cost." /></a><div class="icnblk_cntnt"><h4 id="niceng217er13.tab10"><a href="/books/NBK586314/table/niceng217er13.tab10/?report=objectonly" target="object" rid-ob="figobniceng217er13tab10">Table 10</a></h4><p class="float-caption no_bottom_margin">Preoperative assessment cost. </p></div></div><p>The centres were also asked about the outcome of patients being assessed for surgery to assess what proportion of those being assessed for surgery proceeds to have a surgical resection. The probability of being a surgery candidate was determined to be 41.3% across all centres. In the model, we add the test of costing those patients that did not go on to have surgery as well as the cost of the surgical patient themselves. So, the total assessment cost per patient undergoing surgery was £8,182 + £11,628 = £19,809, where £11,628=£81,812*(58.7%)/41.3%.</p></div><div id="niceng217er13.s1.3.9.4"><h5>Cost-effectiveness Results</h5><p>The base case probabilistic model results indicated surgery was cost-effective at NICE’s £20,000 threshold with a cost per QALY of £11,425. The total cost for surgery was higher compared to medical management (£56,204 compared to £31,627), but the total QALYs were also higher for surgery (15.91 compared to 13.76). The higher cost for surgery was largely driven by the high cost of assessment for resective epilepsy surgery and procedure costs. Greater QALYs for surgery were obtained because more people receiving resective epilepsy surgery achieve seizure freedom compared to those receiving medical management, and higher standardised mortality ratios are associated with people who are not seizure-free.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er13tab11"><a href="/books/NBK586314/table/niceng217er13.tab11/?report=objectonly" target="object" title="Table 11" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er13tab11" rid-ob="figobniceng217er13tab11"><img class="small-thumb" src="/books/NBK586314/table/niceng217er13.tab11/?report=thumb" src-large="/books/NBK586314/table/niceng217er13.tab11/?report=previmg" alt="Table 11. Base case cost effectiveness results (probabilistic)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er13.tab11"><a href="/books/NBK586314/table/niceng217er13.tab11/?report=objectonly" target="object" rid-ob="figobniceng217er13tab11">Table 11</a></h4><p class="float-caption no_bottom_margin">Base case cost effectiveness results (probabilistic). </p></div></div><p>The sensitivity analyses showed that the results were a little sensitive to the utility values, and costs, but only when the time horizon was lowered (to 15 years) did the cost per QALY gained exceed the £20,000 per QALY gained threshold - <a class="figpopup" href="/books/NBK586314/table/niceng217er13.tab12/?report=objectonly" target="object" rid-figpopup="figniceng217er13tab12" rid-ob="figobniceng217er13tab12">Table 12</a>. Only when all the most pessimistic assumptions were made did the cost per QALY gained exceed £30,000 per QALY gained.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng217er13tab12"><a href="/books/NBK586314/table/niceng217er13.tab12/?report=objectonly" target="object" title="Table 12" class="img_link icnblk_img figpopup" rid-figpopup="figniceng217er13tab12" rid-ob="figobniceng217er13tab12"><img class="small-thumb" src="/books/NBK586314/table/niceng217er13.tab12/?report=thumb" src-large="/books/NBK586314/table/niceng217er13.tab12/?report=previmg" alt="Table 12. Sensitivity analysis (deterministic)." /></a><div class="icnblk_cntnt"><h4 id="niceng217er13.tab12"><a href="/books/NBK586314/table/niceng217er13.tab12/?report=objectonly" target="object" rid-ob="figobniceng217er13tab12">Table 12</a></h4><p class="float-caption no_bottom_margin">Sensitivity analysis (deterministic). </p></div></div></div></div><div id="niceng217er13.s1.3.10"><h4>1.3.10. Unit costs</h4><p>Please see unit cost presented in <a href="#niceng217er13.s1.2.6">section 1.2.6</a>.</p></div><div id="niceng217er13.s1.3.11"><h4>1.3.11. Evidence statements</h4><div id="niceng217er13.s1.3.11.1"><h5>Economic</h5><ul><li class="half_rhythm"><div>One cost-utility analysis found that fluorodeoxyglucose positron emission tomography and fluorodeoxyglucose positron emission tomography plus intracranial electroencephalography were cost-effective compared to medical management (ICER: £1,671 per QALY gained and £1,925 per QALY gained respectively). This study was assessed as partially applicable with minor limitations (Burch 2012).</div></li><li class="half_rhythm"><div>One cost-utility analysis found that subdural grid electrodes and stereoelectroencephalography were cost-effective compared to medical management (ICER: £2,802 per QALY gained and £4,284 per QALY gained respectively). This study was assessed as partially applicable with minor limitations (Kovacs 2021).</div></li><li class="half_rhythm"><div>One original cost-utility analysis found that resective epilepsy surgery in adults is cost effective compared to medical management for treating drug-refractory epilepsy (ICER: £11,425 per QALY gained). This study was assessed as directly applicable with minor limitations.</div></li></ul></div></div></div><div id="niceng217er13.s1.4"><h3>1.4. The committee’s discussion and interpretation of the evidence</h3><div id="niceng217er13.s1.4.1"><h4>1.4.1. The outcomes that matter most</h4><p>The most important outcome was agreed by the committee to be quality of life, as this encapsulates the effects of treatment most relevant to the person with epilepsy. Other outcomes of similar importance were mortality, seizure recurrence, serious adverse events and cognition. Mortality and seizure recurrence were regarded as highly relevant outcomes to evaluate the potential harms of <u>not</u> using surgery, whilst serious adverse events and cognition were deemed the outcomes best suited to measure the harms of surgery itself. Although serious adverse events and cognition had originally been deemed non-critical outcomes at the protocol stage, it became apparent during discussion of the evidence that these were centrally important to decisions concerning recommendation of surgical intervention, because they could have a significant impact on function. All other outcomes were deemed important but less liable to affect recommendation decisions.</p></div><div id="niceng217er13.s1.4.2"><h4>1.4.2. The quality of the evidence</h4><p>The evidence included for this review was for resective surgery only. Quality of the evidence ranged from ‘high’ to ‘very low’. The most common reasons for downgrading of ratings were imprecision and risk of bias. The committee noted that imprecision was related to a lack of power in the included studies, which had relatively small sample sizes. The risk of bias was usually related to a lack of blinding (2 studies) or lack of allocation concealment (1 study). Given the nature of the interventions, surgery versus waiting list control, lack of blinding was inevitable. Therefore, the committee agreed that despite the risk of bias ratings, the studies were well conducted, and the overall quality was good. The committee was relatively confident of the validity of the evidence and supported a strong recommendation for surgery in both adults and children.</p></div><div id="niceng217er13.s1.4.3"><h4>1.4.3. Benefits and harms</h4><p>The committee agreed that surgery led to much better improvements in quality of life than medical care and that this was a crucial benefit of surgery for both children and adults with drug=resistant epilepsy. This benefit was generally of large magnitude, suggesting an effect that would be noticeable and important to the person with epilepsy, and it was also highly unlikely to be due to chance (sampling error). The committee also agreed that the greater reductions in seizure recurrence resulting from surgery would be an important benefit to the patient, particularly in view of the large effect size observed from the time to event data. Although surgery’s relative effects on mortality were small and consistent with possible sampling error, the committee stated that the single death occurring in the medical care group was made more significant by virtue of it being: sudden and unexpected. This suggested it might be due to SUDEP, which was viewed by the committee as potential harm resulting from <i>not</i> providing surgery in a timely fashion.</p><p>The committee also weighed up the accompanying harms of surgery in terms of clear examples of greater cognitive deficits post-surgery in the studies. The committee questioned whether pre-surgical methods such as the sodium amobarbital procedure (Wada test) had been carried out in the studies to try to reduce the likelihood of these harmful effects occurring. The fact that these methods had not been used in the included studies suggested that the reported cognitive defects might not always be an inevitable result of surgery, as they might, in practice, be ameliorated to some extent by suitable pre-surgical assessment strategies.</p><p>The cognitive tests showing harms for surgery were discussed further in some detail by the committee. In relation to the ‘Boston Naming Test’, members of the committee explained how patients often find that deficits in this test do not always translate to dysfunction in everyday life, and that the majority of patients would accept living with a reduction in naming capacity. Furthermore, it was discussed how there are approaches that may be used to minimise any disability caused by naming difficulties. These might include standard interventions offered by speech and language therapists and neuropsychologists, such as phonologic and orthographic cues, semantic feature analysis, contingency-based cueing hierarchies, and repeated conversational engagement. With respect to the ‘delayed recall test’, the committee accepted that the reported deficits were a more intractable problem, as there were few ways of avoiding them. It was described how such deficits are manifested in about a third of cases by a cognitive ‘aging’ of around 10 years. However, the committee stressed that the risks of cognitive decline when <i>having</i> surgery were comparable to the risk of SUDEP when <i>not</i> having surgery. Given that cognitive decline is less serious than death, the committee agreed that the benefits of surgery were not negated by the evidence of cognitive decline.</p><p>The other serious adverse events observed in the studies, such as motor deficits, were also discussed, but the consensus was that these largely self-limiting effects did not shift the overall balance of benefits and harms away from an overall benefit for surgery. The committee acknowledged the importance of counselling as part of a surgical workup to discuss the balance between risks and benefits of surgery with patients or their carers to enable informed decision making.</p><p>The committee also discussed how the balance of benefits and risks depends on the complexity of the surgery, with more complex surgery leading to less benefits and more risks. In relation to this, the committee discussed how paediatric epilepsy surgery was very often more complex than adult surgery. For example, paediatric surgery would often involve more extratemporal surgery, as well as potentially risky procedures such as hemispherotomy or corpus callosotomy. However, it was agreed that even in very complex paediatric surgery the balance of benefits and harm from surgery would often still be superior to that of medical care.</p><p>The committee noted that no evidence had been found for surgery in people with learning disabilities and discussed that this population are less likely to have surgery. This may happen because of difficulties in gaining consent, or they are not referred due to a belief they would be unable to cope with the surgical assessment. In addition, the committee referred to evidence that this group might have poorer outcomes from surgery because of intractable brain pathology. The committee also noted people with genetic abnormalities may also sometimes be excluded from referral for a surgical assessment, and agreed that people with learning disabilities and those with genetic abnormalities should be considered for surgical assessment when it is indicated.</p><p>The committee agreed that any referral for surgery should be made as soon as a person had been identified as appropriate for surgery. It was agreed that early referral would avoid unnecessary risks resulting from further seizures during a waiting period, without any attendant benefits from such a delay. The committee discussed the reasons why delays tend to occur before referrals are made, even when a patient is clearly suitable for surgery. General misunderstanding of what surgery can offer was offered as a major reason, and it was discussed how improved education of clinicians was important.</p><p>The committee was therefore unanimous that the overall clinical benefits of surgery should make it an option for everyone – both adults and children - with drug-resistant epilepsy i.e., has tried two or more ASMs and is experiencing at least 2 seizures a month. The need to make decisions based on the individual patient’s characteristics and wishes was stressed, but it was also discussed how all patients with drug-resistant epilepsy should be given an opportunity to be referred to a tertiary centre that could consider a surgical strategy for the patient. The committee agreed that an adult with drug-resistant epilepsy should be referred to a specialist tertiary centre, and a child should be referred to a tertiary paediatric neurology service, both for consideration of surgical treatment, as early as possible.</p></div><div id="niceng217er13.s1.4.4"><h4>1.4.4. Cost effectiveness and resource use</h4><p>Two economic evaluations were identified for the review question assessing the cost-effectiveness of resective epilepsy surgery (Burch 2012 & Kovacs 2021). No economic evaluations were identified for the review question assessing the criteria for assessment for resective epilepsy surgery.</p><p>Burch 2012 assessed the cost effectiveness of testing strategies for assessment for resective epilepsy surgery following discordant EEG and MRI findings from a UK NHS and personal social services perspective. They compared three strategies:
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<ol><li class="half_rhythm"><div>Medical management (MM)</div></li><li class="half_rhythm"><div>Patients received FDG-PET.
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<ol class="lower-alpha"><li class="half_rhythm"><div>if the results of the preoperative assessment test were positive (e.g., the epileptic zone was located, and resective epilepsy surgery was feasible), patients received surgery.</div></li><li class="half_rhythm"><div>If the results of the FDG-PET were negative or uncertain, patients received MM.</div></li></ol></div></li><li class="half_rhythm"><div>Patients first received FDG-PET.
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<ol class="lower-alpha"><li class="half_rhythm"><div>Then, as in intervention 2, if the results were positive, patients received surgery,</div></li><li class="half_rhythm"><div>if the results were negative, patients received MM.</div></li><li class="half_rhythm"><div>where the results of the test were uncertain patients received an iEEG.
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<ol class="lower-roman"><li class="half_rhythm"><div>A positive iEEG resulted in surgery being undertaken and</div></li><li class="half_rhythm"><div>a negative or uncertain result led to continued treatment with MM.</div></li></ol></div></li></ol></div></li></ol></p><p>For FDG-PET compared to MM the cost was £1,671 per QALY gained, and for FDG-PET +iEEG compared to MM, it was £1,925 per QALY gained.</p><p>Kovacs 2021 also assessed the cost-effectiveness of three different strategies from a Hungarian health care perspective. The cost-utility analysis undertaken by Kovacs 2021 was based on the cost-effectiveness analysis undertaken by Burch 2012, with differences in some of the data inputs used to populate the model and the preoperative assessment tests being evaluated. In Kovacs 2021. MM was compared to two different types of iEEG monitoring – placement of subdural grid electrodes (SDG) and stereotactic implantation of depth electrodes (SEEG). If localisation of the epileptic zone was identified, resective epilepsy surgery would be conducted. However, if the iEEG was unsuccessful in identifying the epileptic zone patients would receive MM. SDG cost an extra £2,802 compared to MM and SEEG cost £4,284 per QALY gained compared to MM.</p><p>Neither of these economic evaluations captured the RCT evidence identified in the clinical review. In addition, the committee noted that some of the data inputs used in these studies might not reflect the majority of epilepsy surgery patients. The target population in these studies would typically be people where the epileptic zone is more difficult to localise as the preoperative assessment tests being evaluated would normally be conducted at the latter stages of the assessment for resective epilepsy surgery pathway. The committee acknowledged that when the epileptic zone is more difficult to localise – and subsequently the area of the brain to resect may not be as well defined – poorer outcomes post-surgery may be observed compared to people where the epileptic zone was identified through fewer preoperative assessment tests.</p><p>The health economic studies included in the review were limited to the cost-effectiveness of specific preoperative assessment tests; therefore, the costs of other preoperative assessment tests were not included in the overall assessment of the cost effectiveness.</p><p>Due to the high clinical and economic importance concerning the cost effectiveness of resective epilepsy surgery original health economic modelling was also undertaken to assess the cost effectiveness of resective epilepsy surgery in adults. Unfortunately, there was insufficient data to model the cost-effectiveness of resective epilepsy surgery in children. The lifetime cost of surgery was higher than for MM (£56,204 and £31,627 respectively) but the QALYs gained were also greater in the surgery arm (15.91 QALYs compared to 13.76 QALYs). Compared with medical management, surgery cost an extra £11,425 per QALY gained, which is below NICE’s £20,000 threshold.</p><p>The clinical evidence included in the review was included in our original health economic analysis; however, it only provided data to populate the data in our 1-year decision tree. This is because it is challenging to conduct long-term RCTs assessing the effectiveness of epilepsy surgery due to cross-over. Observational data was therefore required to inform the long-term effectiveness of surgery and MM. A large long-term observational study based on a UK population (de Tisi 2011) was used to populate the long-term effectiveness outcomes for people after epilepsy surgery. However, there were fewer data available for a drug refractory population who continue MM. These data were subsequently taken from Callaghan 2011, which evaluated the remission and relapse rate in a drug-resistant epilepsy cohort of 246 patients from the USA. In de Tisi 2011, data were reported up to 15 years and in Callaghan 2011 data were reported up to 5 years. To account for the potential uncertainties in the long-term (lifetime) data for both surgery and medical management, a sensitivity analysis was conducted using a 15-year time horizon. Although, at 15 years, there is still uncertainty over medical management because data in Callaghan 2011, was limited to 5-year follow-up. In this analysis, the cost per QALY gained was £28,231, which is above NICE’s £20,000 threshold but below NICE’s £30,000 threshold. However, the committee thought that this was conservative, and it is reasonable to assume that the impact of surgery can continue for longer than 15 years for most individuals.</p><p>In most long-term outcome studies (including de Tisi 2011) assessing epilepsy surgery, seizure freedom was defined as being completely seizure-free <u>or</u> with only simple partial seizures, now termed focal-aware seizures (FAS). This is reasonable but this definition did not correspond with the definition used in the trials or the studies that were sourced for health state utility scores and standardised mortality ratios, which were only people who were completely seizure-free. To overcome the challenges posed by these differential definitions, adjustments were made to the standardised mortality ratios (SMRs) and utilities for seizure freedom in the surgery arm using the proportion of people that experienced FAS in de Tisi 2011. The utility and mortality for people experiencing only FAS is not known, and so conservative assumptions were made, which if anything, might have under-estimated the benefits of surgery, but as only 18% of people of the seizure-free sample had experienced FAS, the committee concluded this would not alter the overall results of the cost-effectiveness analysis.</p><p>Callaghan 2011’s definition of drug refractory epilepsy was stricter than the current definition of drug refractory. Callaghan defined drug-resistant epilepsy as people who had failed on at least two antiseizure medications (ASMs) and were experiencing at least one seizure per month. The current ILAE definition of drug refractory epilepsy is the occurrence of uncontrolled seizures despite two tolerated and appropriately chosen ASMs. Therefore, the cohort of people in Callaghan 2011 may have had more severe drug refectory epilepsy compared to a drug-resistant cohort as defined by the ILAE definition. The committee did, however, note that the estimated proportion of people entering seizure freedom (5.6%) and relapsing (22%) each year seemed reasonable.</p><p>The committee discussed how the results of the adult epilepsy model may translate into a paediatric population. The committee discussed that the cost of pre-surgical evaluation may be more expensive for children as they might require additional tests. However, the committee noted seizure freedom after resective epilepsy surgery might be more likely in children than adults, and the benefits for children could be accrued over a longer period.<a class="bibr" href="#niceng217er13.ref33" rid="niceng217er13.ref33"><sup>33</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er13.ref34" rid="niceng217er13.ref34"><sup>34</sup></a></p><p>There is also some evidence that if seizure-free they are more likely to be able to stop taking anti-seizure medication,<a class="bibr" href="#niceng217er13.ref33" rid="niceng217er13.ref33"><sup>33</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er13.ref34" rid="niceng217er13.ref34"><sup>34</sup></a> which would be cost-saving in the longer term. In addition, the committee noted children with drug refractory epilepsy are likely to have more outpatient appointments than adults. Therefore, rendering children seizure could result in additional downstream cost savings because less outpatient appointments are required for people rendered seizure-free. Additional studies have shown children with drug refractory epilepsy who receive surgery have, better cognitive development, better outcomes in school, and greater chances of employment in adult life compared to those who continue to receive MM.<a class="bibr" href="#niceng217er13.ref8" rid="niceng217er13.ref8"><sup>8</sup></a><sup>,</sup>
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<a class="bibr" href="#niceng217er13.ref64" rid="niceng217er13.ref64"><sup>64</sup></a><sup>–</sup><a class="bibr" href="#niceng217er13.ref66" rid="niceng217er13.ref66"><sup>66</sup></a></p><p>A lifetime re-operation rate of 4% was incorporated in the adult, model and the committee concluded this rate of 4% would likely be similar in a paediatric population. The committee did, however, note that for children undergoing resective epilepsy surgery, the need for re-operation may also arise in adulthood which would incur additional costs however, this is only for a small proportion of people. The committee concluded that the cost savings observed in a paediatric population would likely outweigh the additional costs that may be incurred from preoperative assessment and additional re-operation in adulthood and therefore concluded resective epilepsy surgery in children is highly likely to be cost-effective.</p><p>Overall, based on the results of the included health economic studies and the original health economic analysis, the committee concluded that resective epilepsy surgery in a drug refractory population is highly likely to be cost-effective in both adults and children. The committee discussed that although there are limitations with the evidence used in the health economic model, these were dealt with in the most appropriate way.</p><p>In current practice, epilepsies services for surgery are managed separately for adults and children. Epilepsy services for children are run by the Children’s Epilepsy Surgery Service (CESS), whereas epilepsy surgery for adults is managed at tertiary epilepsy centres. The CESS centres were developed to increase the levels of paediatric resective epilepsy surgery in England. Since CESS was developed, the number of children undergoing preoperative assessment and resective epilepsy surgery in children has increased. The committee noted that the target number of referrals for preoperative assessment set by CESS, are currently below target. Target levels for preoperative assessment and resective epilepsy surgery are predicted by CESS epidemiologically. The committee concluded the recommendations made would help CESS achieve their targets and therefore are not expected to result in a substantial resource impact.</p><p>Resective epilepsy surgery is provided for adults at tertiary epilepsy centres. However, the committee noted that levels of referral for epilepsy surgery are sub-optimal. The committee prioritised this area for original health economic modelling in the hope they could recommend everyone with drug refractory epilepsy be referred for pre-surgical evaluation.</p><p>The health economic model incorporated the cost of pre-surgical evaluation in the total costs of surgery (including the costs for people who were referred for surgery and underwent pre-surgical evaluation but did not go on to have surgery). Sensitivity analyses were also conducted, assuming a higher and lower cost for assessment for resective epilepsy surgery. This was calculated at the highest cost out of the nine participating centres and the lowest cost. When the higher cost was used, resective epilepsy was still cost-effective (£16,827 per QALY gained). The committee noted that this cost for assessment of resective epilepsy (£13,178) is likely more reflective of being undergoing more complex preoperative assessments.</p><p>Overall, as surgery was assessed to be cost effective the committee concluded they were able to make a strong recommendation to refer adults, children and young people with drug resistant epilepsy for assessment for resective surgery.</p><p>The committee noted that in current practice referral to an epilepsy surgery centre for people who are drug refractory can take years. This is due to several factors, such as the misconception of clinical uncertainty surrounding the efficacy of surgery or healthcare professionals taking a view that referral should be a ‘last resort’ once a large number of ASMs have been tried. The committee discussed that once a person has failed two appropriately chosen ASMs the chances of obtaining seizure freedom through use of ASMs diminishes significantly. The committee noted that referral to an epilepsy surgery centre to enter the assessment for resective epilepsy surgery pathway does not necessarily mean surgery will take place for the patient in question. A person may not be an eligible candidate for epilepsy surgery, or they may not wish to proceed with surgery. Given all of the data presented, the committee was, though, clear that people with drug-resistant epilepsy should be referred promptly to a tertiary epilepsy centre for consideration of epilepsy surgery.</p><p>This recommendation may lead to a substantial resource impact as more adults will likely be referred for assessment for resective epilepsy surgery. The degree of the impact will be dependent on how many people decide to undergo assessment for resective epilepsy once referred because the assessment for resective epilepsy surgery is resource intensive. The committee noted that even if more people are referred for assessment for resective epilepsy the proportion of people who are eligible for surgery and proceed to resective epilepsy surgery is unlikely to change substantially.</p></div><div id="niceng217er13.s1.4.5"><h4>1.4.5. Other factors the committee took into account</h4><p>The committee noted that the evidence was only in people who were already drug-resistant, and that the comparator in these studies was medical management. This initially suggests a certain bias in the studies over and above that evaluated in the risk of bias assessments, resulting from the samples being made up of people who would be predisposed to do badly on the comparator treatment. This would naturally increase the likelihood for the intervention to appear superior. However, it was also realised that there are only two established ways to treat epilepsy – drugs or surgery. If the drugs work well, then surgery would probably not be contemplated, but if the drugs are ineffective, then surgery is a viable option. Hence it is correct that surgery should be tested for efficacy in the population where the drugs don’t achieve their aim.</p></div><div id="niceng217er13.s1.4.6"><h4>1.4.6. Recommendations supported by this evidence review</h4><p>This evidence review supports recommendations 8.2.1 – 8.2.4.</p></div></div></div><div id="niceng217er13.rl.r1"><h2 id="_niceng217er13_rl_r1_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="niceng217er13.ref1">Alexiades
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NG, McKhann
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GM. Seizing the moment: A randomized trial of surgery for drug-resistant pediatric epilepsy. Clinical Neurosurgery. 2018; 82(3):N31–N32 [<a href="https://pubmed.ncbi.nlm.nih.gov/29462442" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29462442</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="niceng217er13.ref2">Annegers
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JF, Coan
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SP, Hauser
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WA, Leestma
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J, Duffell
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W, Tarver
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B. Epilepsy, vagal nerve stimulation by the NCP system, mortality, and sudden, unexpected, unexplained death. Epilepsia. 1998; 39(2):206–212 [<a href="https://pubmed.ncbi.nlm.nih.gov/9578002" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9578002</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="niceng217er13.ref3">Ansari
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SF, Tubbs
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RS, Terry
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CL, Cohen-Gadol
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AA. Surgery for extratemporal nonlesional epilepsy in adults: an outcome meta-analysis. Acta Neurochirurgica. 2010; 152(8):1299–1305 [<a href="https://pubmed.ncbi.nlm.nih.gov/20524016" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20524016</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="niceng217er13.ref4">Bazil
|
|
CW. Epilepsy surgery: still underutilized after all these years. Current Neurology and Neuroscience Reports. 2012; 12(4):348–349 [<a href="https://pubmed.ncbi.nlm.nih.gov/22622409" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22622409</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>5.</dt><dd><div class="bk_ref" id="niceng217er13.ref5">Bien
|
|
CG, Kurthen
|
|
M, Baron
|
|
K, Lux
|
|
S, Helmstaedter
|
|
C, Schramm
|
|
J
|
|
et al. Long-term seizure outcome and antiepileptic drug treatment in surgically treated temporal lobe epilepsy patients: a controlled study. Epilepsia. 2001; 42(11):1416–1421 [<a href="https://pubmed.ncbi.nlm.nih.gov/11879344" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11879344</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>6.</dt><dd><div class="bk_ref" id="niceng217er13.ref6">Bien
|
|
CG, Schulze-Bonhage
|
|
A, Soeder
|
|
BM, Schramm
|
|
J, Elger
|
|
CE, Tiemeier
|
|
H. Assessment of the long-term effects of epilepsy surgery with three different reference groups. Epilepsia. 2006; 47(11):1865–1869 [<a href="https://pubmed.ncbi.nlm.nih.gov/17116026" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17116026</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>7.</dt><dd><div class="bk_ref" id="niceng217er13.ref7">BMJ Group and the Royal Pharmaceutical Society of Great Britain. British National Formulary. Available from: <a href="https://www.evidence.nhs.uk/formulary/bnf/current" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.evidence<wbr style="display:inline-block"></wbr>​.nhs.uk/formulary/bnf/current</a> Last accessed: 04 April 2017.</div></dd></dl><dl class="bkr_refwrap"><dt>8.</dt><dd><div class="bk_ref" id="niceng217er13.ref8">Boshuisen
|
|
K, van Schooneveld
|
|
MM, Uiterwaal
|
|
CS, Cross
|
|
JH, Harrison
|
|
S, Polster
|
|
T
|
|
et al. Intelligence quotient improves after antiepileptic drug withdrawal following pediatric epilepsy surgery. Annals of Neurology. 2015; 78(1):104–114 [<a href="https://pubmed.ncbi.nlm.nih.gov/25899932" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25899932</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>9.</dt><dd><div class="bk_ref" id="niceng217er13.ref9">Bowen
|
|
JM, Snead
|
|
OC, Chandra
|
|
K, Blackhouse
|
|
G, Goeree
|
|
R. Epilepsy care in Ontario: an economic analysis of increasing access to epilepsy surgery. Ontario Health Technology Assessment Series. 2012; 12(18):1–41 [<a href="/pmc/articles/PMC3428718/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3428718</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23074428" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23074428</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="niceng217er13.ref10">Burch
|
|
J, Hinde
|
|
S, Palmer
|
|
S, Beyer
|
|
F, J
|
|
MI, Marson
|
|
A
|
|
et al. The clinical effectiveness and cost-effectiveness of technologies used to visualise the seizure focus in people with refractory epilepsy being considered for surgery: a systematic review and decision-analytical model. Health Technology Assessment. 2012; 16(34):1–164 [<a href="https://pubmed.ncbi.nlm.nih.gov/22985954" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22985954</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="niceng217er13.ref11">Callaghan
|
|
B, Schlesinger
|
|
M, Rodemer
|
|
W, Pollard
|
|
J, Hesdorffer
|
|
D, Allen Hauser
|
|
W
|
|
et al. Remission and relapse in a drug-resistant epilepsy population followed prospectively. Epilepsia. 2011; 52(3):619–626 [<a href="/pmc/articles/PMC3147304/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3147304</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21269287" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21269287</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="niceng217er13.ref12">Catchpool
|
|
M, Dalziel
|
|
K, Mahardya
|
|
RTK, Harvey
|
|
AS. Cost-effectiveness of epileptic surgery compared with medical treatment in children with drug-resistant epilepsy. Epilepsy & Behavior. 2019; 97:253–259 [<a href="https://pubmed.ncbi.nlm.nih.gov/31254845" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31254845</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="niceng217er13.ref13">Chan
|
|
AY, Rolston
|
|
JD, Lee
|
|
B, Vadera
|
|
S, Englot
|
|
DJ. Rates and predictors of seizure outcome after corpus callosotomy for drug-resistant epilepsy: A meta-analysis. Journal of Neurosurgery. 2019; 130(4):1193–1202 [<a href="/pmc/articles/PMC6274594/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6274594</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29999448" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29999448</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="niceng217er13.ref14">Choi
|
|
H, Sell
|
|
RL, Lenert
|
|
L, Muennig
|
|
P, Goodman
|
|
RR, Gilliam
|
|
FG
|
|
et al. Epilepsy surgery for pharmacoresistant temporal lobe epilepsy: a decision analysis. JAMA. 2008; 300(21):2497–2505 [<a href="https://pubmed.ncbi.nlm.nih.gov/19050193" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19050193</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="niceng217er13.ref15">Conte
|
|
F, Van Paesschen
|
|
W, Legros
|
|
B, Depondt
|
|
C. The Epilepsy Surgery Grading Scale: Validation in an independent population with drug-resistant focal epilepsy. Epilepsia. 2019; 60(8):e78–e82 [<a href="https://pubmed.ncbi.nlm.nih.gov/31247119" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31247119</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="niceng217er13.ref16">de Tisi
|
|
J, Bell
|
|
GS, Peacock
|
|
JL, McEvoy
|
|
AW, Harkness
|
|
WF, Sander
|
|
JW
|
|
et al. The long-term outcome of adult epilepsy surgery, patterns of seizure remission, and relapse: a cohort study. Lancet. 2011; 378(9800):1388–1395 [<a href="https://pubmed.ncbi.nlm.nih.gov/22000136" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22000136</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="niceng217er13.ref17">Ding
|
|
P, Liang
|
|
S, Zhang
|
|
S, Zhang
|
|
J, Hu
|
|
X, Yu
|
|
X. Resective surgery combined with corpus callosotomy for children with non-focal lesional Lennox-Gastaut syndrome. Acta Neurochirurgica. 2016; 158(11):2177–2184 [<a href="https://pubmed.ncbi.nlm.nih.gov/27629372" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27629372</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="niceng217er13.ref18">Dwivedi
|
|
R, Ramanujam
|
|
B, Chandra
|
|
PS, Sapra
|
|
S, Gulati
|
|
S, Kalaivani
|
|
M
|
|
et al. Surgery for drug-resistant epilepsy in children. New England Journal of Medicine. 2017; 377(17):1639–1647 [<a href="https://pubmed.ncbi.nlm.nih.gov/29069568" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29069568</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="niceng217er13.ref19">Engel
|
|
J, Jr., McDermott
|
|
MP, Wiebe
|
|
S, Langfitt
|
|
JT, Stern
|
|
JM, Dewar
|
|
S
|
|
et al. Early surgical therapy for drug-resistant temporal lobe epilepsy: a randomized trial. JAMA. 2012; 307(9):922–930 [<a href="/pmc/articles/PMC4821633/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4821633</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22396514" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22396514</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="niceng217er13.ref20">Englot
|
|
DJ, Breshears
|
|
JD, Sun
|
|
PP, Chang
|
|
EF, Auguste
|
|
KI. Seizure outcomes after resective surgery for extra-temporal lobe epilepsy in pediatric patients: A systematic review. Journal of Neurosurgery: Pediatrics. 2013; 12(2):126–133 [<a href="https://pubmed.ncbi.nlm.nih.gov/23768201" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23768201</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="niceng217er13.ref21">Fiest
|
|
KM, Sajobi
|
|
TT, Wiebe
|
|
S. Epilepsy surgery and meaningful improvements in quality of life: results from a randomized controlled trial. Epilepsia. 2014; 55(6):886–892 [<a href="https://pubmed.ncbi.nlm.nih.gov/24735200" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24735200</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="niceng217er13.ref22">Gloss
|
|
D, Nevitt
|
|
SJ, Staba
|
|
R. The role of high-frequency oscillations in epilepsy surgery planning. Cochrane Database of Systematic Reviews
|
|
2017, Issue 10. Art. No.: CD010235. DOI: 10.1002/14651858.CD010235.pub3. [<a href="/pmc/articles/PMC6485644/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6485644</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28981957" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28981957</span></a>] [<a href="http://dx.crossref.org/10.1002/14651858.CD010235.pub3" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="niceng217er13.ref23">Hinde
|
|
S, Soares
|
|
M, Burch
|
|
J, Marson
|
|
A, Woolacott
|
|
N, Palmer
|
|
S. The added clinical and economic value of diagnostic testing for epilepsy surgery. Epilepsy Research. 2014; 108(4):775–781 [<a href="/pmc/articles/PMC4000270/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4000270</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24630045" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24630045</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="niceng217er13.ref24">Holler
|
|
Y, Kutil
|
|
R, Klaffenbock
|
|
L, Thomschewski
|
|
A, Holler
|
|
PM, Bathke
|
|
AC
|
|
et al. High-frequency oscillations in epilepsy and surgical outcome. A meta-analysis. Frontiers in Human Neuroscience. 2015; 9:574 [<a href="/pmc/articles/PMC4611152/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4611152</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26539097" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26539097</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="niceng217er13.ref25">Jacoby
|
|
A, Buck
|
|
D, Baker
|
|
G, McNamee
|
|
P, Graham-Jones
|
|
S, Chadwick
|
|
D. Uptake and costs of care for epilepsy: findings from a U.K. regional study. Epilepsia. 1998; 39(7):776–786 [<a href="https://pubmed.ncbi.nlm.nih.gov/9670907" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9670907</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>26.</dt><dd><div class="bk_ref" id="niceng217er13.ref26">Janszky
|
|
J, Kovacs
|
|
N, Gyimesi
|
|
C, Fogarasi
|
|
A, Doczi
|
|
T, Wiebe
|
|
S. Epilepsy surgery, antiepileptic drug trials, and the role of evidence. Epilepsia. 2010; 51(6):1004–1009 [<a href="https://pubmed.ncbi.nlm.nih.gov/20384716" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20384716</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>27.</dt><dd><div class="bk_ref" id="niceng217er13.ref27">Jardim
|
|
AP, Corso
|
|
JT, Garcia
|
|
MT, Gaca
|
|
LB, Comper
|
|
SM, Lancellotti
|
|
CL
|
|
et al. Hippocampal atrophy on MRI is predictive of histopathological patterns and surgical prognosis in mesial temporal lobe epilepsy with hippocampal sclerosis. Epilepsy Research. 2016; 128:169–175 [<a href="https://pubmed.ncbi.nlm.nih.gov/27842262" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27842262</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="niceng217er13.ref28">Jehi
|
|
L, Yardi
|
|
R, Chagin
|
|
K, Tassi
|
|
L, Russo
|
|
GL, Worrell
|
|
G
|
|
et al. Development and validation of nomograms to provide individualised predictions of seizure outcomes after epilepsy surgery: a retrospective analysis. Lancet Neurology. 2015; 14(3):283–290 [<a href="https://pubmed.ncbi.nlm.nih.gov/25638640" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25638640</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="niceng217er13.ref29">Kovacs
|
|
S, Toth
|
|
M, Janszky
|
|
J, Doczi
|
|
T, Fabo
|
|
D, Boncz
|
|
I
|
|
et al. Cost-effectiveness analysis of invasive EEG monitoring in drug-resistant epilepsy. Epilepsy & Behavior. 2021; 114(Pt A):107488 [<a href="https://pubmed.ncbi.nlm.nih.gov/33257296" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33257296</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="niceng217er13.ref30">Kwan
|
|
P, Sperling
|
|
MR. Refractory seizures: try additional antiepileptic drugs (after two have failed) or go directly to early surgery evaluation?
|
|
Epilepsia. 2009; 50(Suppl 8):57–62 [<a href="https://pubmed.ncbi.nlm.nih.gov/19702735" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19702735</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="niceng217er13.ref31">Kwon
|
|
CS, Chang
|
|
EF, Jette
|
|
N. Cost-effectiveness of advanced imaging technologies in the presurgical workup of epilepsy. Epilepsy Currents. 2020; 20(1):7–11 [<a href="/pmc/articles/PMC7020533/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7020533</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31910665" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31910665</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="niceng217er13.ref32">Kwon
|
|
CS, Neal
|
|
J, Tellez-Zenteno
|
|
J, Metcalfe
|
|
A, Fitzgerald
|
|
K, Hernandez-Ronquillo
|
|
L
|
|
et al. Resective focal epilepsy surgery - Has selection of candidates changed? A systematic review. Epilepsy Research. 2016; 122:37–43 [<a href="https://pubmed.ncbi.nlm.nih.gov/26921855" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26921855</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>33.</dt><dd><div class="bk_ref" id="niceng217er13.ref33">Lamberink
|
|
H, Otte
|
|
W, Blümcke
|
|
I, Braun
|
|
K. Supplement to: Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis: a retrospective multicentre cohort study. Lancet Neurology. 2020; 19:748–757 [<a href="https://pubmed.ncbi.nlm.nih.gov/32822635" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32822635</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>34.</dt><dd><div class="bk_ref" id="niceng217er13.ref34">Lamberink
|
|
HJ, Otte
|
|
WM, Blümcke
|
|
I, Braun
|
|
KPJ. Seizure outcome and use of antiepileptic drugs after epilepsy surgery according to histopathological diagnosis: a retrospective multicentre cohort study. Lancet Neurology. 2020; 19(9):748–757 [<a href="https://pubmed.ncbi.nlm.nih.gov/32822635" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32822635</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>35.</dt><dd><div class="bk_ref" id="niceng217er13.ref35">Malhotra
|
|
V, Chandra
|
|
SP, Dash
|
|
D, Garg
|
|
A, Tripathi
|
|
M, Bal
|
|
CS
|
|
et al. A screening tool to identify surgical candidates with drug refractory epilepsy in a resource limited settings. Epilepsy Research. 2016; 121:14–20 [<a href="https://pubmed.ncbi.nlm.nih.gov/26855366" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26855366</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>36.</dt><dd><div class="bk_ref" id="niceng217er13.ref36">Nashef
|
|
L, Fish
|
|
DR, Sander
|
|
JW, Shorvon
|
|
SD. Incidence of sudden unexpected death in an adult outpatient cohort with epilepsy at a tertiary referral centre. Journal of Neurology, Neurosurgery and Psychiatry. 1995; 58(4):462–464 [<a href="/pmc/articles/PMC1073434/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1073434</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/7738555" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7738555</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>37.</dt><dd><div class="bk_ref" id="niceng217er13.ref37">National Clinical Guideline Centre. The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care: pharmacological update of clinical guideline 20. NICE clinical guideline 137. London. National Clinical Guideline Centre, 2011. Available from: <a href="http://guidance.nice.org.uk/CG137" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://guidance<wbr style="display:inline-block"></wbr>​.nice.org.uk/CG137</a></div></dd></dl><dl class="bkr_refwrap"><dt>38.</dt><dd><div class="bk_ref" id="niceng217er13.ref38">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual [updated October 2020]. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.nice.org.uk<wbr style="display:inline-block"></wbr>​/article/PMG20/chapter<wbr style="display:inline-block"></wbr>​/1%20Introduction%20and%20overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>39.</dt><dd><div class="bk_ref" id="niceng217er13.ref39">Negishi
|
|
M, Martuzzi
|
|
R, Novotny
|
|
EJ, Spencer
|
|
DD, Constable
|
|
RT. Functional MRI connectivity as a predictor of the surgical outcome of epilepsy. Epilepsia. 2011; 52(9):1733–1740 [<a href="/pmc/articles/PMC3169719/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3169719</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21801165" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21801165</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>40.</dt><dd><div class="bk_ref" id="niceng217er13.ref40">Newberg
|
|
AB, Alavi
|
|
A, Berlin
|
|
J, Mozley
|
|
PD, O’Connor
|
|
M, Sperling
|
|
M. Ipsilateral and contralateral thalamic hypometabolism as a predictor of outcome after temporal lobectomy for seizures. Journal of Nuclear Medicine. 2000; 41(12):1964–1968 [<a href="https://pubmed.ncbi.nlm.nih.gov/11138679" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11138679</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>41.</dt><dd><div class="bk_ref" id="niceng217er13.ref41">Nguyen
|
|
D, Tayah
|
|
T, Bouthillier
|
|
A, Berube
|
|
A, Cossette
|
|
P, P
|
|
FI
|
|
et al. Magnetoencephalography for presurgical evaluation of nonlesional refractory epilepsy. Epilepsy Currents. 2013; 13(Suppl 1):1087</div></dd></dl><dl class="bkr_refwrap"><dt>42.</dt><dd><div class="bk_ref" id="niceng217er13.ref42">NHS England and NHS Improvement. 2019/20 National Cost Collection data. 2021. Available from: <a href="https://www.england.nhs.uk/national-cost-collection/#ncc1920" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.england.nhs<wbr style="display:inline-block"></wbr>​.uk/national-cost-collection/#ncc1920</a> Last accessed: 18/06/2021.</div></dd></dl><dl class="bkr_refwrap"><dt>43.</dt><dd><div class="bk_ref" id="niceng217er13.ref43">Nilsson
|
|
L, Ahlbom
|
|
A, Farahmand
|
|
BY, Tomson
|
|
T. Mortality in a population-based cohort of epilepsy surgery patients. Epilepsia. 2003; 44(4):575–581 [<a href="https://pubmed.ncbi.nlm.nih.gov/12681008" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12681008</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>44.</dt><dd><div class="bk_ref" id="niceng217er13.ref44">O’Brien
|
|
TJ, Miles
|
|
K, Ware
|
|
R, Cook
|
|
MJ, Binns
|
|
DS, Hicks
|
|
RJ. The cost-effective use of 18F-FDG PET in the presurgical evaluation of medically refractory focal epilepsy. Journal of Nuclear Medicine. 2008; 49(6):931–937 [<a href="https://pubmed.ncbi.nlm.nih.gov/18483097" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18483097</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>45.</dt><dd><div class="bk_ref" id="niceng217er13.ref45">Obaid
|
|
S, Fallah
|
|
A, Bouthillier
|
|
A, Crevier
|
|
L. Efficacy and safety of MR-guided laser interstitial thermoablative therapy (MRgLITT) for drug-resistant epilepsy. Neuro-Chirurgie. 2017; 63(1):36</div></dd></dl><dl class="bkr_refwrap"><dt>46.</dt><dd><div class="bk_ref" id="niceng217er13.ref46">Office for National Statistics. National life tables, UK: 2015 to 2017. 2018. Available from: <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/nationallifetablesunitedkingdom/2015to2017" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.ons.gov.uk<wbr style="display:inline-block"></wbr>​/peoplepopulationandcommunity<wbr style="display:inline-block"></wbr>​/birthsdeathsandmarriages<wbr style="display:inline-block"></wbr>​/lifeexpectancies<wbr style="display:inline-block"></wbr>​/bulletins<wbr style="display:inline-block"></wbr>​/nationallifetablesunitedkingdom<wbr style="display:inline-block"></wbr>​/2015to2017</a> Last accessed: 01/07/2021.</div></dd></dl><dl class="bkr_refwrap"><dt>47.</dt><dd><div class="bk_ref" id="niceng217er13.ref47">Organisation for Economic Co-operation and Development (OECD). Purchasing power parities (PPP). Available from: <a href="http://www.oecd.org/std/ppp" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.oecd.org/std/ppp</a> Last accessed: 13/05/2021.</div></dd></dl><dl class="bkr_refwrap"><dt>48.</dt><dd><div class="bk_ref" id="niceng217er13.ref48">Panebianco
|
|
M, Rigby
|
|
A, Weston
|
|
J, Marson
|
|
AG. Vagus nerve stimulation for partial seizures. Cochrane Database of Systematic Reviews
|
|
2015, Issue 4. Art. No.: CD002896. DOI: 10.1002/14651858.CD002896.pub2. [<a href="/pmc/articles/PMC7138043/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7138043</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25835947" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25835947</span></a>] [<a href="http://dx.crossref.org/10.1002/14651858.CD002896.pub2" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd></dl><dl class="bkr_refwrap"><dt>49.</dt><dd><div class="bk_ref" id="niceng217er13.ref49">Patil
|
|
SG, Cross
|
|
JH, Kling Chong
|
|
W, Boyd
|
|
SG, Harkness
|
|
WJ, Neville
|
|
BGR
|
|
et al. Is streamlined evaluation of children for epilepsy surgery possible?
|
|
Epilepsia. 2008; 49(8):1340–1347 [<a href="https://pubmed.ncbi.nlm.nih.gov/18325011" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18325011</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>50.</dt><dd><div class="bk_ref" id="niceng217er13.ref50">Picot
|
|
MC, Jaussent
|
|
A, Neveu
|
|
D, Kahane
|
|
P, Crespel
|
|
A, Gelisse
|
|
P
|
|
et al. Costeffectiveness analysis of epilepsy surgery in a controlled cohort of adult patients with intractable partial epilepsy: A 5-year follow-up study. Epilepsia. 2016; 57(10):1669–1679 [<a href="https://pubmed.ncbi.nlm.nih.gov/27595433" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27595433</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>51.</dt><dd><div class="bk_ref" id="niceng217er13.ref51">Pindrik
|
|
J, Hoang
|
|
N, Smith
|
|
L, Halverson
|
|
M, Wojnaroski
|
|
M, McNally
|
|
K
|
|
et al. Preoperative evaluation and surgical management of infants and toddlers with drug-resistant epilepsy. Neurosurgical Focus. 2018; 45(3):E3 [<a href="https://pubmed.ncbi.nlm.nih.gov/30173613" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30173613</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>52.</dt><dd><div class="bk_ref" id="niceng217er13.ref52">Punia
|
|
V, Abdelkader
|
|
A, Busch
|
|
RM, Gonzalez-Martinez
|
|
J, Bingaman
|
|
W, Najm
|
|
I
|
|
et al. Time to push the age limit: Epilepsy surgery in patients 60 years or older. Epilepsia Open. 2018; 3(1):73–80 [<a href="/pmc/articles/PMC5839305/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5839305</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29588990" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29588990</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>53.</dt><dd><div class="bk_ref" id="niceng217er13.ref53">Ramanujam
|
|
B, Bharti
|
|
K, Viswanathan
|
|
V, Garg
|
|
A, Bal
|
|
C, Chandra
|
|
PS
|
|
et al. Can ictal-MEG obviate the need for phase II monitoring in people with drug-refractory epilepsy? A prospective observational study. Seizure. 2017; 45:17–23 [<a href="https://pubmed.ncbi.nlm.nih.gov/27912111" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27912111</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>54.</dt><dd><div class="bk_ref" id="niceng217er13.ref54">Ryvlin
|
|
P, Bouvard
|
|
S, Le Bars
|
|
D, De Lamerie
|
|
G, Gregoire
|
|
MC, Kahane
|
|
P
|
|
et al. Clinical utility of flumazenil-PET versus [18F]fluorodeoxyglucose-PET and MRI in refractory partial epilepsy. A prospective study in 100 patients. Brain. 1998; 121(11):2067–2081 [<a href="https://pubmed.ncbi.nlm.nih.gov/9827767" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9827767</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>55.</dt><dd><div class="bk_ref" id="niceng217er13.ref55">Ryvlin
|
|
P, Rheims
|
|
S. Epilepsy surgery: Eligibility criteria and presurgical evaluation. Dialogues in Clinical Neuroscience. 2008; 10(1):91–103 [<a href="/pmc/articles/PMC3181859/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3181859</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18472487" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18472487</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>56.</dt><dd><div class="bk_ref" id="niceng217er13.ref56">Ryvlin
|
|
P, Rheims
|
|
S. Predicting epilepsy surgery outcome. Current Opinion in Neurology. 2016; 29(2):182–188 [<a href="https://pubmed.ncbi.nlm.nih.gov/26886359" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26886359</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>57.</dt><dd><div class="bk_ref" id="niceng217er13.ref57">Salam
|
|
S, Watson
|
|
C, Griessenauer
|
|
C, Blount
|
|
J. Hemispherectomy for intractable epilepsy in the pediatric age group: Systematic review and meta-analysis. Epilepsy Currents. 2014; 14(Suppl 1):234–235</div></dd></dl><dl class="bkr_refwrap"><dt>58.</dt><dd><div class="bk_ref" id="niceng217er13.ref58">Salanova
|
|
V, Markand
|
|
O, Worth
|
|
R. Temporal lobe epilepsy surgery: outcome, complications, and late mortality rate in 215 patients. Epilepsia. 2002; 43(2):170–174 [<a href="https://pubmed.ncbi.nlm.nih.gov/11903464" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11903464</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>59.</dt><dd><div class="bk_ref" id="niceng217er13.ref59">Schmidt
|
|
D, Baumgartner
|
|
C, Loscher
|
|
W. The chance of cure following surgery for drug-resistant temporal lobe epilepsy. What do we know and do we need to revise our expectations?
|
|
Epilepsy Research. 2004; 60(2–3):187–201 [<a href="https://pubmed.ncbi.nlm.nih.gov/15380563" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15380563</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>60.</dt><dd><div class="bk_ref" id="niceng217er13.ref60">See
|
|
SJ, Jehi
|
|
LE, Vadera
|
|
S, Bulacio
|
|
J, Najm
|
|
I, Bingaman
|
|
W. Surgical outcomes in patients with extratemporal epilepsy and subtle or normal magnetic resonance imaging findings. Neurosurgery. 2013; 73(1):68–76; discussion 76-67 [<a href="https://pubmed.ncbi.nlm.nih.gov/23615090" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23615090</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>61.</dt><dd><div class="bk_ref" id="niceng217er13.ref61">Seghezzi
|
|
S, Del Sole
|
|
A, Villani
|
|
F, Didato
|
|
G, Mai
|
|
R, Gozzo
|
|
F
|
|
et al. The role of 18F-FDG PET/CT in the assessment of epileptogenic focus in medically intractable epilepsy: Comparison with invasive and non-invasive techniques and prognostic value. Clinical and Translational Imaging. 2013; 1:1–38</div></dd></dl><dl class="bkr_refwrap"><dt>62.</dt><dd><div class="bk_ref" id="niceng217er13.ref62">Sellner
|
|
J, Trinka
|
|
E. Clinical characteristics, risk factors and pre-surgical evaluation of post-infectious epilepsy. European Journal of Neurology. 2013; 20(3):429–439 [<a href="https://pubmed.ncbi.nlm.nih.gov/22943580" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22943580</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>63.</dt><dd><div class="bk_ref" id="niceng217er13.ref63">Sisodiya
|
|
SM, Moran
|
|
N, Free
|
|
SL, Kitchen
|
|
ND, Stevens
|
|
JM, Harkness
|
|
WF
|
|
et al. Correlation of widespread preoperative magnetic resonance imaging changes with unsuccessful surgery for hippocampal sclerosis. Annals of Neurology. 1997; 41(4):490–496 [<a href="https://pubmed.ncbi.nlm.nih.gov/9124806" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9124806</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>64.</dt><dd><div class="bk_ref" id="niceng217er13.ref64">Skirrow
|
|
C, Cross
|
|
JH, Cormack
|
|
F, Harkness
|
|
W, Vargha-Khadem
|
|
F, Baldeweg
|
|
T. Long-term intellectual outcome after temporal lobe surgery in childhood. Neurology. 2011; 76(15):1330–1337 [<a href="/pmc/articles/PMC3090063/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3090063</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21482948" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21482948</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>65.</dt><dd><div class="bk_ref" id="niceng217er13.ref65">Skirrow
|
|
C, Cross
|
|
JH, Harrison
|
|
S, Cormack
|
|
F, Harkness
|
|
W, Coleman
|
|
R
|
|
et al. Temporal lobe surgery in childhood and neuroanatomical predictors of long-term declarative memory outcome. Brain. 2015; 138(Pt 1):80–93 [<a href="/pmc/articles/PMC4285190/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4285190</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25392199" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25392199</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>66.</dt><dd><div class="bk_ref" id="niceng217er13.ref66">Skirrow
|
|
C, Cross
|
|
JH, Owens
|
|
R, Weiss-Croft
|
|
L, Martin-Sanfilippo
|
|
P, Banks
|
|
T
|
|
et al. Determinants of IQ outcome after focal epilepsy surgery in childhood: A longitudinal case-control neuroimaging study. Epilepsia. 2019; 60(5):872–884 [<a href="https://pubmed.ncbi.nlm.nih.gov/30968956" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30968956</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>67.</dt><dd><div class="bk_ref" id="niceng217er13.ref67">Sperling
|
|
MR, Feldman
|
|
H, Kinman
|
|
J, Liporace
|
|
JD, O’Connor
|
|
MJ. Seizure control and mortality in epilepsy. Annals of Neurology. 1999; 46(1):45–50 [<a href="https://pubmed.ncbi.nlm.nih.gov/10401779" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10401779</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>68.</dt><dd><div class="bk_ref" id="niceng217er13.ref68">Steinbrenner
|
|
M, Kowski
|
|
AB, Holtkamp
|
|
M. Referral to evaluation for epilepsy surgery: Reluctance by epileptologists and patients. Epilepsia. 2019; 60(2):211–219 [<a href="https://pubmed.ncbi.nlm.nih.gov/30653659" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30653659</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>69.</dt><dd><div class="bk_ref" id="niceng217er13.ref69">Struck
|
|
AF, Hall
|
|
LT, Floberg
|
|
JM, Perlman
|
|
SB, Dulli
|
|
DA. Surgical decision making in temporal lobe epilepsy: a comparison of [(18)F]FDG-PET, MRI, and EEG. Epilepsy & Behavior. 2011; 22(2):293–297 [<a href="/pmc/articles/PMC3260654/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3260654</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21798813" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21798813</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>70.</dt><dd><div class="bk_ref" id="niceng217er13.ref70">Stylianou
|
|
P, Kimchi
|
|
G, Hoffmann
|
|
C, Blat
|
|
I, Harnof
|
|
S. Neuroimaging for patient selection for medial temporal lobe epilepsy surgery: Part 2 functional neuroimaging. Journal of Clinical Neuroscience. 2016; 23:23–33 [<a href="https://pubmed.ncbi.nlm.nih.gov/26453282" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26453282</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>71.</dt><dd><div class="bk_ref" id="niceng217er13.ref71">Suarez-Pinera
|
|
M, Mestre-Fusco
|
|
A, Ley
|
|
M, Gonzalez
|
|
S, Medrano
|
|
S, Principe
|
|
A
|
|
et al. Perfusion SPECT, SISCOM and PET (18)F-FDG in the assessment of drug-refractory epilepsy patients candidates for epilepsy surgery. Revista Espanola de Medicina Nuclear e Imagen Molecular. 2015; 34(6):350–357 [<a href="https://pubmed.ncbi.nlm.nih.gov/26118354" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26118354</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>72.</dt><dd><div class="bk_ref" id="niceng217er13.ref72">Sutherling
|
|
WW, Mamelak
|
|
AN, Thyerlei
|
|
D, Maleeva
|
|
T, Minazad
|
|
Y, Philpott
|
|
L
|
|
et al. Influence of magnetic source imaging for planning intracranial EEG in epilepsy. Neurology. 2008; 71(13):990–996 [<a href="/pmc/articles/PMC2676955/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2676955</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18809834" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18809834</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>73.</dt><dd><div class="bk_ref" id="niceng217er13.ref73">Szaflarski
|
|
JP, Gloss
|
|
D, Binder
|
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JR, Gaillard
|
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WD, Golby
|
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AJ, Holland
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SK
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et al. Practice guideline summary: Use of fMRI in the presurgical evaluation of patients with epilepsy. Neurology. 2017; 88(4):395–402 [<a href="/pmc/articles/PMC5272968/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5272968</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28077494" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28077494</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>74.</dt><dd><div class="bk_ref" id="niceng217er13.ref74">Uijl
|
|
SG, Leijten
|
|
FS, Arends
|
|
JB, Parra
|
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J, van Huffelen
|
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AC, Moons
|
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KG. The added value of [18F]-fluoro-D-deoxyglucose positron emission tomography in screening for temporal lobe epilepsy surgery. Epilepsia. 2007; 48(11):2121–2129 [<a href="https://pubmed.ncbi.nlm.nih.gov/17651417" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17651417</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>75.</dt><dd><div class="bk_ref" id="niceng217er13.ref75">Uijl
|
|
SG, Leijten
|
|
FS, Arends
|
|
JB, Parra
|
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J, van Huffelen
|
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AC, Moons
|
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KG. Decision-making in temporal lobe epilepsy surgery: the contribution of basic non-invasive tests. Seizure. 2008; 17(4):364–373 [<a href="https://pubmed.ncbi.nlm.nih.gov/18164218" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18164218</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>76.</dt><dd><div class="bk_ref" id="niceng217er13.ref76">Uijl
|
|
SG, Leijten
|
|
FS, Arends
|
|
JB, Parra
|
|
J, van Huffelen
|
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AC, Moons
|
|
KG. Prognosis after temporal lobe epilepsy surgery: the value of combining predictors. Epilepsia. 2008; 49(8):1317–1323 [<a href="https://pubmed.ncbi.nlm.nih.gov/18557776" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18557776</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>77.</dt><dd><div class="bk_ref" id="niceng217er13.ref77">Vaatainen
|
|
S, Soini
|
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E, Peltola
|
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J, Charokopou
|
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M, Taiha
|
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M, Kalviainen
|
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R. Economic value of adjunctive brivaracetam treatment strategy for focal onset seizures in finland. Advances in Therapy. 2020; 37(1):477–500 [<a href="/pmc/articles/PMC6979440/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6979440</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31808053" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31808053</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>78.</dt><dd><div class="bk_ref" id="niceng217er13.ref78">Vickrey
|
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BG. Mortality in a consecutive cohort of 248 adolescents and adults who underwent diagnostic evaluation for epilepsy surgery. Epilepsia. 1997; 38(Suppl 11):S67–S69 [<a href="https://pubmed.ncbi.nlm.nih.gov/19909332" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19909332</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>79.</dt><dd><div class="bk_ref" id="niceng217er13.ref79">Vickrey
|
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BG, Hays
|
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RD, Rausch
|
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R, Engel
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J, Jr., Visscher
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BR, Ary
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CM
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et al. Outcomes in 248 patients who had diagnostic evaluations for epilepsy surgery. Lancet. 1995; 346(8988):1445–1449 [<a href="https://pubmed.ncbi.nlm.nih.gov/7490989" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7490989</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>80.</dt><dd><div class="bk_ref" id="niceng217er13.ref80">Wang
|
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HJ, Tan
|
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G, Zhu
|
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LN, Chen
|
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D, Xu
|
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D, Chu
|
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SS
|
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et al. Predictors of seizure reduction outcome after vagus nerve stimulation in drug-resistant epilepsy. Seizure. 2019; 66:53–60 [<a href="https://pubmed.ncbi.nlm.nih.gov/30802843" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30802843</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>81.</dt><dd><div class="bk_ref" id="niceng217er13.ref81">West
|
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S, Nevitt
|
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S, Cotton
|
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J, Gandhi
|
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S, Weston
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J, Sudan
|
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A
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et al. Surgery for epilepsy. Cochrane Database of Systematic Reviews
|
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2019, Issue 6. Art. No.: CD010541. DOI: 10.1002/14651858.CD010541.pub3. [<a href="/pmc/articles/PMC6591702/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6591702</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31237346" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31237346</span></a>] [<a href="http://dx.crossref.org/10.1002/14651858.CD010541.pub3" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></dd></dl><dl class="bkr_refwrap"><dt>82.</dt><dd><div class="bk_ref" id="niceng217er13.ref82">Widjaja
|
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E, Li
|
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B, Schinkel
|
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CD, Ritchie
|
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LP, Weaver
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J, Snead
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OC
|
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et al. Costeffectiveness of pediatric epilepsy surgery compared to medical treatment in children with intractable epilepsy. Epilepsy Research. 2011; 94(1–2):61–68 [<a href="https://pubmed.ncbi.nlm.nih.gov/21306874" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21306874</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>83.</dt><dd><div class="bk_ref" id="niceng217er13.ref83">Wiebe
|
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S, Blume
|
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WT, Girvin
|
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JP, Eliasziw
|
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M, Effectiveness and Efficiency of Surgery for Temporal Lobe Epilepsy Study Group. A randomized, controlled trial of surgery for temporal-lobe epilepsy. New England Journal of Medicine. 2001; 345(5):311–318 [<a href="https://pubmed.ncbi.nlm.nih.gov/11484687" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11484687</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>84.</dt><dd><div class="bk_ref" id="niceng217er13.ref84">Wiebe
|
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S, Jette
|
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N. Epilepsy surgery utilization: who, when, where, and why?
|
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Current Opinion in Neurology. 2012; 25(2):187–193 [<a href="https://pubmed.ncbi.nlm.nih.gov/22322412" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22322412</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>85.</dt><dd><div class="bk_ref" id="niceng217er13.ref85">Wiebe
|
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S, Seiam
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A, Dhaliwal
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H. Impact of epilepsy surgery on quality of life: How one asks, determines what one finds. Epilepsia. 2009; 50(Suppl 10):123</div></dd></dl><dl class="bkr_refwrap"><dt>86.</dt><dd><div class="bk_ref" id="niceng217er13.ref86">Wieser
|
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HG, Ortega
|
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M, Friedman
|
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A, Yonekawa
|
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Y. Long-term seizure outcomes following amygdalohippocampectomy. Journal of Neurosurgery. 2003; 98(4):751–763 [<a href="https://pubmed.ncbi.nlm.nih.gov/12691400" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12691400</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>87.</dt><dd><div class="bk_ref" id="niceng217er13.ref87">Willmann
|
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O, Wennberg
|
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R, May
|
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T, Woermann
|
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FG, Pohlmann-Eden
|
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B. The contribution of 18F-FDG PET in preoperative epilepsy surgery evaluation for patients with temporal lobe epilepsy A meta-analysis. Seizure. 2007; 16(6):509–520 [<a href="https://pubmed.ncbi.nlm.nih.gov/17532231" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17532231</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>88.</dt><dd><div class="bk_ref" id="niceng217er13.ref88">Wright
|
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CW, Hassnain
|
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K, Englot
|
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DJ, Chang
|
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E. Vagus nerve stimulation for drug-resistant epilepsy: Predictors and rates of seizure freedom (10768). Neuromodulation. 2016; 19(3):e87 [<a href="/pmc/articles/PMC4884552/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4884552</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26645965" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26645965</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>89.</dt><dd><div class="bk_ref" id="niceng217er13.ref89">Yan
|
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H, Toyota
|
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E, Anderson
|
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M, Abel
|
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TJ, Donner
|
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E, Kalia
|
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SK
|
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et al. A systematic review of deep brain stimulation for the treatment of drug-resistant epilepsy in childhood. Journal of Neurosurgery: Pediatrics. 2019; 23(3):274–284 [<a href="https://pubmed.ncbi.nlm.nih.gov/30544364" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30544364</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>90.</dt><dd><div class="bk_ref" id="niceng217er13.ref90">Yang
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PF, Jia
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YZ, Lin
|
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Q, Mei
|
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Z, Chen
|
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ZQ, Zheng
|
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ZY
|
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et al. Intractable occipital lobe epilepsy: clinical characteristics, surgical treatment, and a systematic review of the literature. Acta Neurochirurgica. 2015; 157(1):63–75 [<a href="https://pubmed.ncbi.nlm.nih.gov/25278241" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25278241</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>91.</dt><dd><div class="bk_ref" id="niceng217er13.ref91">Yin
|
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ZR, Kang
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HC, Wu
|
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W, Wang
|
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M, Zhu
|
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SQ. Do neuroimaging results impact prognosis of epilepsy surgery? A meta-analysis. Journal of Huazhong University of Science and Technology Medical Sciences. 2013; 33(2):159–165 [<a href="https://pubmed.ncbi.nlm.nih.gov/23592123" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23592123</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>92.</dt><dd><div class="bk_ref" id="niceng217er13.ref92">Zhang
|
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CH, Lu
|
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Y, Brinkmann
|
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B, Welker
|
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K, Worrell
|
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G, He
|
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B. Lateralization and localization of epilepsy related hemodynamic foci using presurgical fMRI. Clinical Neurophysiology. 2015; 126(1):27–38 [<a href="/pmc/articles/PMC4214895/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4214895</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24856460" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24856460</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>93.</dt><dd><div class="bk_ref" id="niceng217er13.ref93">Zhang
|
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J, Liu
|
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W, Chen
|
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H, Xia
|
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H, Zhou
|
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Z, Mei
|
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S
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et al. Identification of common predictors of surgical outcomes for epilepsy surgery. Neuropsychiatric Disease and Treatment. 2013; 9:1673–1682 [<a href="/pmc/articles/PMC3825696/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3825696</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24235833" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24235833</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>94.</dt><dd><div class="bk_ref" id="niceng217er13.ref94">Zhang
|
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J, Liu
|
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W, Chen
|
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H, Xia
|
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H, Zhou
|
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Z, Mei
|
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S
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et al. Multimodal neuroimaging in presurgical evaluation of drug-resistant epilepsy. NeuroImage Clinical. 2014; 4:35–44 [<a href="/pmc/articles/PMC3840005/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3840005</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24282678" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24282678</span></a>]</div></dd></dl></dl></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng217er13.appa"><h3>Appendix A. Review protocols</h3><div id="niceng217er13.appa.s1"><h4>A.1. Review protocol for surgery referral criteria</h4><p id="niceng217er13.appa.et1"><a href="/books/NBK586314/bin/niceng217er13-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (173K)</span></p></div><div id="niceng217er13.appa.s2"><h4>A.2. Review protocol for surgical interventions</h4><p id="niceng217er13.appa.et2"><a href="/books/NBK586314/bin/niceng217er13-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (229K)</span></p></div><div id="niceng217er13.appa.s3"><h4>A.3. Health economic review protocol</h4><p id="niceng217er13.appa.et3"><a href="/books/NBK586314/bin/niceng217er13-appa-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (171K)</span></p></div></div><div id="niceng217er13.appb"><h3>Appendix B. Literature search strategies</h3><div id="niceng217er13.appb.s1"><h4>B.1. Surgical interventions</h4><p id="niceng217er13.appb.et1"><a href="/books/NBK586314/bin/niceng217er13-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (269K)</span></p></div><div id="niceng217er13.appb.s2"><h4>B.2. Referral for surgery</h4><p id="niceng217er13.appb.et2"><a href="/books/NBK586314/bin/niceng217er13-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (270K)</span></p></div></div><div id="niceng217er13.appc"><h3>Appendix C. Effectiveness evidence study selection</h3><p id="niceng217er13.appc.et1"><a href="/books/NBK586314/bin/niceng217er13-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 3. Flow chart of clinical study selection for the review of referral for surgery</a><span class="small"> (PDF, 121K)</span></p><p id="niceng217er13.appc.et2"><a href="/books/NBK586314/bin/niceng217er13-appc-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 4. Flow chart of clinical study selection for the review of surgical interventions</a><span class="small"> (PDF, 113K)</span></p></div><div id="niceng217er13.appd"><h3>Appendix D. Economic evidence study selection</h3><p id="niceng217er13.appd.et1"><a href="/books/NBK586314/bin/niceng217er13-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (135K)</span></p></div><div id="niceng217er13.appe"><h3>Appendix E. Economic evidence tables</h3><p>None.</p></div><div id="niceng217er13.appf"><h3>Appendix F. Health economic model</h3><p>No original economic modelling was undertaken for this review question.</p></div><div id="niceng217er13.appg"><h3>Appendix G. Excluded studies</h3><div id="niceng217er13.appg.s1"><h4>G.1. Referral to surgery</h4><p id="niceng217er13.appg.et1"><a href="/books/NBK586314/bin/niceng217er13-appg-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (158K)</span></p></div><div id="niceng217er13.appg.s2"><h4>G.2. Surgical interventions</h4><p id="niceng217er13.appg.et2"><a href="/books/NBK586314/bin/niceng217er13-appg-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (138K)</span></p></div></div><div id="niceng217er13.apph"><h3>Appendix H. Effectiveness evidence</h3><p id="niceng217er13.apph.et1"><a href="/books/NBK586314/bin/niceng217er13-apph-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (216K)</span></p></div><div id="niceng217er13.appi"><h3>Appendix I. Forest plots</h3><div id="niceng217er13.appi.s1"><h4>I.1. Surgery versus waitlist-control/medical treatment</h4><p id="niceng217er13.appi.et1"><a href="/books/NBK586314/bin/niceng217er13-appi-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (265K)</span></p></div></div><div id="niceng217er13.appj"><h3>Appendix J. GRADE tables</h3><p id="niceng217er13.appj.et1"><a href="/books/NBK586314/bin/niceng217er13-appj-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 17. Clinical evidence profile: surgery versus waitlist-control/medical treatment</a><span class="small"> (PDF, 177K)</span></p></div><div id="niceng217er13.appk"><h3>Appendix K. Economic evidence tables</h3><p id="niceng217er13.appk.et1"><a href="/books/NBK586314/bin/niceng217er13-appk-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (222K)</span></p></div><div id="niceng217er13.appl"><h3>Appendix L. Health economic model</h3><p>An original cost-utility analysis was developed, assessing the cost-effectiveness of resective epilepsy surgery in adults with drug refectory epilepsy. Original health economic modelling was also planned to model the cost-effectiveness of resective epilepsy surgery in children, but insufficient data were available to model for this population. Full details of the health economic analysis can be found in the Economic analysis report.</p><p>The committee identified this as a high priority area as they thought there could be a reluctance to refer people for resective epilepsy surgery. The committee wanted to demonstrate benefits of resective epilepsy in terms of improved seizure freedom and long-term cost savings.</p><p>The model can be found in the supplementary data submitted with the guideline.</p></div></div></div><div class="fm-sec"><div><p>FINAL</p></div><div><p>Evidence review underpinning recommendations 8.2.1 – 8.2.4 in the NICE guideline</p><p>Developed by the National Guideline Centre</p></div><div><p><b>Disclaimer</b>: The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2022.</div><div class="small"><span class="label">Bookshelf ID: NBK586314</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/36395297" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">36395297</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng217er13tab1"><div id="niceng217er13.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586314/table/niceng217er13.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er13.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng217er13.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng217er13.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Inclusion: all children, young people and adults with epilepsy.</p>
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<p>Exclusion: new-born babies (under 28 days).</p>
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</td></tr><tr><th id="hd_b_niceng217er13.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions</th><td headers="hd_b_niceng217er13.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Any referral criteria that have been evaluated.</p>
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<p>Strata: None.</p>
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</td></tr><tr><th id="hd_b_niceng217er13.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_niceng217er13.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other referral criteria.</td></tr><tr><th id="hd_b_niceng217er13.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng217er13.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Appropriateness of referral decisions.</td></tr><tr><th id="hd_b_niceng217er13.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng217er13.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RCTs. If no RCTs are found, non-randomised comparisons will be sought. If so, these papers will need to demonstrate that consideration has been made for any potential confounders.</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng217er13tab2"><div id="niceng217er13.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Costs of pre-surgical evaluation tests</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586314/table/niceng217er13.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er13.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Resource</th><th id="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unit costs</th><th id="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Source</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">History and examination</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£240</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs 2019/20. Currency code: WF01B Consultant led, Non-Admitted Face-to-Face Attendance, First, Service code 400,</td></tr><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Videotelemetry</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£2,791</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Currency code: AA80Z, Elective</td></tr><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Neuropsychology assessment</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£334</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Currency code: AA32Z, Outpatient procedures</td></tr><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Neuropsychiatry assessment</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£346</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs 2019/20. Currency code: WF01B Consultant-led, Non-Admitted Face-to-Face Attendance, First, Service code 656</td></tr><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MRI</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£146</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs 2019/20. Currency code: RD01A Magnetic Resonance Imaging Scan of One Area, without Contrast, 19 years and over</td></tr><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PET</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£666</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs 2019/20. Currency code RN01A Positron Emission Tomography with Computed Tomography (PET-CT) of One Area, 19 years and over</td></tr><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Occupational therapy</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£111</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs 2019/20. Currency code WF01B Consultant led, Non-Admitted Face-to-Face Attendance, First, Service code 651</td></tr><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Physiotherapy</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£59</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs 2019/20. Currency code WF01B Consultant led, Non-Admitted Face-to-Face Attendance, First, Service code 650</td></tr><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">sEEG</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£14,638</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs 2019/20. Currency code: Currency code AA83Z Elective Intracranial Telemetry</td></tr><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">SPECT</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£342</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs 2019/20. Currency code RN04A Single Photon Emission Computed Tomography with Computed Tomography (SPECT-CT) of One Area, 19 years and over</td></tr><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">fMRI</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£146</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Committee opinion (the same cost for MRI)</td></tr><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Amytal testing</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£3,545</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Committee opinion</td></tr><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MEG</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£2,000 - £4,500</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Committee opinion</td></tr><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ECoG</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£3,000 - £5,000</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Committee opinion</td></tr><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multidisciplinary team meeting</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£250</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs 2019/20. Currency code: WF02B Consultant led, Multi-professional Non-Admitted Face-to-Face Attendance, First, Service code 150</td></tr><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pre-surgical counselling</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£346</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs 2019/20. Currency code: WF01B Consultant-led, Non-Admitted Face-to-Face Attendance, First, Service code 656</td></tr><tr><td headers="hd_h_niceng217er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Informed consent assessment</td><td headers="hd_h_niceng217er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£224</td><td headers="hd_h_niceng217er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs 2019/20. Currency code: WF01B, Consultant led, Non-Admitted Face-to-Face Attendance, First, Service code 150</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: NHS reference costs 2019/20<a class="bibr" href="#niceng217er13.ref42" rid="niceng217er13.ref42"><sup>42</sup></a> and committee opinion</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er13tab3"><div id="niceng217er13.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Costs of surgery</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586314/table/niceng217er13.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er13.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er13.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Resource</th><th id="hd_h_niceng217er13.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unit costs</th><th id="hd_h_niceng217er13.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Activity</th><th id="hd_h_niceng217er13.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Source</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er13.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>AA50A, AA50B, AA50C</p>
|
|
<p>Very Complex Intracranial Procedures, 19 years and over.</p>
|
|
<p>Weighted average of CC scores 0-5, 6-11 and 12+</p>
|
|
</td><td headers="hd_h_niceng217er13.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£15,940</td><td headers="hd_h_niceng217er13.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">656</td><td headers="hd_h_niceng217er13.tab3_1_1_1_4" rowspan="8" colspan="1" style="text-align:left;vertical-align:top;">NHS reference costs 2018/19</td></tr><tr><td headers="hd_h_niceng217er13.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>AA51A, AA51B , AA51C, AA51D</p>
|
|
<p>Complex Intracranial Procedures, 19 years and over.</p>
|
|
<p>Weighted average of CC scores 0-3, 4-7, 8-11, and 12+</p>
|
|
</td><td headers="hd_h_niceng217er13.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£9,975</td><td headers="hd_h_niceng217er13.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2,067</td></tr><tr><td headers="hd_h_niceng217er13.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>AA52A, AA52B , AA52C, AA52D</p>
|
|
<p>Very Major Intracranial Procedures, 19 years and over.</p>
|
|
<p>Weighted average of CC scores 0-3, 4-7, 8-11, and 12+</p>
|
|
</td><td headers="hd_h_niceng217er13.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£9,020</td><td headers="hd_h_niceng217er13.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3,230</td></tr><tr><td headers="hd_h_niceng217er13.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>AA53A, AA53B, AA53C, AA53D</p>
|
|
<p>Major Intracranial Procedures, 19 years and over.</p>
|
|
<p>Weighted average of CC scores 0-3, 4-7, 8-11, and 12+</p>
|
|
</td><td headers="hd_h_niceng217er13.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£7,504</td><td headers="hd_h_niceng217er13.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3,925</td></tr><tr><td headers="hd_h_niceng217er13.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>AA50D, AA50E, AA50F</p>
|
|
<p>Very Complex Intracranial Procedures, 18 years and under.</p>
|
|
<p>Weighted average of CC scores 0-5, 6-11, and 12+</p>
|
|
</td><td headers="hd_h_niceng217er13.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£14,010</td><td headers="hd_h_niceng217er13.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">176</td></tr><tr><td headers="hd_h_niceng217er13.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>AA51E, AA51F, AA51G</p>
|
|
<p>Complex Intracranial Procedures, 18 years and under.</p>
|
|
<p>Weighted average of CC scores 0-3, 4-7, and 8+</p>
|
|
</td><td headers="hd_h_niceng217er13.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£10,093</td><td headers="hd_h_niceng217er13.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">405</td></tr><tr><td headers="hd_h_niceng217er13.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>AA52E, AA52F, AA52G</p>
|
|
<p>Very Major Intracranial Procedures, 18 years and under.</p>
|
|
<p>Weighted average of CC scores 0-3, 4-7, and 8+</p>
|
|
</td><td headers="hd_h_niceng217er13.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£8,020</td><td headers="hd_h_niceng217er13.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">458</td></tr><tr><td headers="hd_h_niceng217er13.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>AA53E, AA53F, AA53G</p>
|
|
<p>Major Intracranial Procedures, 18 years and under.</p>
|
|
<p>Weighted average of CC scores 0-3, 4-7, and 8+</p>
|
|
</td><td headers="hd_h_niceng217er13.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£7,440</td><td headers="hd_h_niceng217er13.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">554</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Source: NHS reference costs 2019/20<a class="bibr" href="#niceng217er13.ref42" rid="niceng217er13.ref42"><sup>42</sup></a></p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er13tab4"><div id="niceng217er13.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Anti-seizure medication costs</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586314/table/niceng217er13.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er13.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er13.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Drug<sup>(a)</sup></th><th id="hd_h_niceng217er13.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Preparation</th><th id="hd_h_niceng217er13.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">Mg/day<sup>(b)</sup></th><th id="hd_h_niceng217er13.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">Cost per year (£)<sup>(c)</sup></th><th id="hd_h_niceng217er13.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">Weighting<sup>(a)</sup></th><th id="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">Total cost</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er13.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Carbamazepine</td><td headers="hd_h_niceng217er13.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Modified-release tablets + tablets</td><td headers="hd_h_niceng217er13.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">1400</td><td headers="hd_h_niceng217er13.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£174</td><td headers="hd_h_niceng217er13.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">20.0%</td><td headers="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£35</td></tr><tr><td headers="hd_h_niceng217er13.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Clobazam</td><td headers="hd_h_niceng217er13.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tablet</td><td headers="hd_h_niceng217er13.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">30</td><td headers="hd_h_niceng217er13.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£137</td><td headers="hd_h_niceng217er13.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">3.9%</td><td headers="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£5</td></tr><tr><td headers="hd_h_niceng217er13.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Levetiracetam</td><td headers="hd_h_niceng217er13.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tablet</td><td headers="hd_h_niceng217er13.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">3000</td><td headers="hd_h_niceng217er13.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£130</td><td headers="hd_h_niceng217er13.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">20.0%</td><td headers="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£26</td></tr><tr><td headers="hd_h_niceng217er13.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lamotrigine</td><td headers="hd_h_niceng217er13.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tablet</td><td headers="hd_h_niceng217er13.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">500</td><td headers="hd_h_niceng217er13.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£75</td><td headers="hd_h_niceng217er13.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">20.0%</td><td headers="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£15</td></tr><tr><td headers="hd_h_niceng217er13.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Perampanel</td><td headers="hd_h_niceng217er13.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tablet</td><td headers="hd_h_niceng217er13.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">6</td><td headers="hd_h_niceng217er13.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£1,825</td><td headers="hd_h_niceng217er13.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">3.9%</td><td headers="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£72</td></tr><tr><td headers="hd_h_niceng217er13.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Phenytoin</td><td headers="hd_h_niceng217er13.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Capsule</td><td headers="hd_h_niceng217er13.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">400</td><td headers="hd_h_niceng217er13.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£299</td><td headers="hd_h_niceng217er13.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">3.9%</td><td headers="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£12</td></tr><tr><td headers="hd_h_niceng217er13.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sodium valproate</td><td headers="hd_h_niceng217er13.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Modified-release tablets + tablets</td><td headers="hd_h_niceng217er13.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2000</td><td headers="hd_h_niceng217er13.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£390</td><td headers="hd_h_niceng217er13.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">3.9%</td><td headers="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£15</td></tr><tr><td headers="hd_h_niceng217er13.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Topiramate</td><td headers="hd_h_niceng217er13.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tablet</td><td headers="hd_h_niceng217er13.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">450</td><td headers="hd_h_niceng217er13.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£513</td><td headers="hd_h_niceng217er13.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">3.9%</td><td headers="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£20</td></tr><tr><td headers="hd_h_niceng217er13.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Zonisamide</td><td headers="hd_h_niceng217er13.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Capsule</td><td headers="hd_h_niceng217er13.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">450</td><td headers="hd_h_niceng217er13.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£213</td><td headers="hd_h_niceng217er13.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">3.9%</td><td headers="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£8</td></tr><tr><td headers="hd_h_niceng217er13.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Lacosamide</td><td headers="hd_h_niceng217er13.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tablet</td><td headers="hd_h_niceng217er13.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">350</td><td headers="hd_h_niceng217er13.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£1,785</td><td headers="hd_h_niceng217er13.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">3.9%</td><td headers="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£70</td></tr><tr><td headers="hd_h_niceng217er13.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eslicarbazepine</td><td headers="hd_h_niceng217er13.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tablet</td><td headers="hd_h_niceng217er13.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">1200</td><td headers="hd_h_niceng217er13.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£1,241</td><td headers="hd_h_niceng217er13.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">3.9%</td><td headers="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£49</td></tr><tr><td headers="hd_h_niceng217er13.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Oxcarbazepine</td><td headers="hd_h_niceng217er13.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tablet</td><td headers="hd_h_niceng217er13.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2100</td><td headers="hd_h_niceng217er13.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£989</td><td headers="hd_h_niceng217er13.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">3.9%</td><td headers="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£39</td></tr><tr><td headers="hd_h_niceng217er13.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Brivaracetam</td><td headers="hd_h_niceng217er13.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tablet</td><td headers="hd_h_niceng217er13.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">150</td><td headers="hd_h_niceng217er13.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£1,267</td><td headers="hd_h_niceng217er13.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">3.9%</td><td headers="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£50</td></tr><tr><td headers="hd_h_niceng217er13.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pregabalin</td><td headers="hd_h_niceng217er13.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Capsule</td><td headers="hd_h_niceng217er13.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">500</td><td headers="hd_h_niceng217er13.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£50</td><td headers="hd_h_niceng217er13.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.3%</td><td headers="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£0.17</td></tr><tr><td headers="hd_h_niceng217er13.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gabapentin</td><td headers="hd_h_niceng217er13.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Capsule</td><td headers="hd_h_niceng217er13.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">3150</td><td headers="hd_h_niceng217er13.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£130</td><td headers="hd_h_niceng217er13.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.3%</td><td headers="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£0.43</td></tr><tr><td headers="hd_h_niceng217er13.tab4_1_1_1_1 hd_h_niceng217er13.tab4_1_1_1_2 hd_h_niceng217er13.tab4_1_1_1_3 hd_h_niceng217er13.tab4_1_1_1_4 hd_h_niceng217er13.tab4_1_1_1_5" colspan="5" rowspan="1" style="text-align:right;vertical-align:top;">
|
|
<b>Total</b>
|
|
</td><td headers="hd_h_niceng217er13.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">
|
|
<b>£417</b>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Sources:</p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng217er13.tab4_1"><p class="no_margin">Committee opinion</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="niceng217er13.tab4_2"><p class="no_margin">Committee opinion and the British National Formulary (BNF)<a class="bibr" href="#niceng217er13.ref7" rid="niceng217er13.ref7"><sup>7</sup></a></p></div></dd></dl><dl class="bkr_refwrap"><dt>(c)</dt><dd><div id="niceng217er13.tab4_3"><p class="no_margin">BNF<a class="bibr" href="#niceng217er13.ref7" rid="niceng217er13.ref7"><sup>7</sup></a>, Date accessed: 16/05/21</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er13tab5"><div id="niceng217er13.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586314/table/niceng217er13.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er13.tab5_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng217er13.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng217er13.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Inclusion: People with treatment-resistant epilepsy*</p>
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<p>Exclusion: New-born babies (under 28 days) with acute symptomatic seizures.</p>
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<p>*Epilepsy in which seizures persist defined by the ILAE as ‘failure of adequate trials of 2 tolerated and appropriately chosen and used antiseizure medication schedules (whether as monotherapy or in combination) to achieve sustained seizure freedom’.</p>
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</td></tr><tr><th id="hd_b_niceng217er13.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions</th><td headers="hd_b_niceng217er13.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Resective surgery:
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<ul><li class="half_rhythm"><div>Temporal lobectomy</div></li><li class="half_rhythm"><div>Extratemporal lobectomy(parietal/frontal/occipital/ insular)</div></li></ul>
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Disconnective surgery:
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<ul><li class="half_rhythm"><div>Callosotomy</div></li><li class="half_rhythm"><div>Hemispherectomy, hemispherotomy.</div></li><li class="half_rhythm"><div>Temporoparietal occipital disconnection</div></li><li class="half_rhythm"><div>Hypothalamic hamartoma disconnection</div></li></ul>
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The different surgery approaches will be pooled under an overall ‘surgery’ heading in the analysis.</td></tr><tr><th id="hd_b_niceng217er13.tab5_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparisons</th><td headers="hd_b_niceng217er13.tab5_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medical management / usual care / wait-list control</td></tr><tr><th id="hd_b_niceng217er13.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng217er13.tab5_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Mortality at short-term follow-up of 12- 24 months and longer-term follow-up of >24-60 months</div></li><li class="half_rhythm"><div>Seizure freedom at short-term follow-up of 12 to 24 months and longer-term follow-up of >24-60 months</div></li><li class="half_rhythm"><div>Due to anticipated heterogeneity in reporting of seizure freedom, data will be extracted as presented within included studies. Where a study reports multiple variants, then all data will be extracted. For decision making priority will be given to data based on hazards (of first seizure) rather than risks or odds.</div></li><li class="half_rhythm"><div>Seizure frequency (50% or greater reduction in seizure frequency) at short-term follow-up of 12 to 24 months and longer-term follow-up of >24-60 month</div></li><li class="half_rhythm"><div>Quality of life (measured with a validated scale) at short-term follow-up of 12 to 24 months and longer-term follow-up of >24-60 months</div></li><li class="half_rhythm"><div>Healthcare resource use</div></li><li class="half_rhythm"><div>Social functioning (measures of adaptive functioning or adaptive behaviour using a validated scale) short-term follow-up of 12 to 24 months and longer-term follow-up of >24-60 months</div></li><li class="half_rhythm"><div>Cognitive outcomes (including neuropsychological measures of global cognitive functioning, executive functioning and memory using a validated scale) short-term follow-up of 12 to 24 months and longer-term follow-up of >24-60 months</div></li><li class="half_rhythm"><div>In children and young people: neurodevelopmental outcomes (behavioural and emotional outcomes measured with a validated scale) short-term follow-up of 12 to 24 months and longer-term follow-up of >24-60 months</div></li><li class="half_rhythm"><div>Serious adverse events (such as infection, stroke, severe bleeding)</div></li></ul></td></tr><tr><th id="hd_b_niceng217er13.tab5_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng217er13.tab5_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>RCTs</p>
|
|
<p>Systematic reviews of RCTs: For a systematic review to be included, it must be conducted to the same methodological standard as NICE guideline reviews. If sufficient details are not provided to include a relevant systematic review, the review will only be used for citation searching.</p>
|
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<p>Non-randomised studies will be included if there is insufficient RCT evidence (less than or equal to 2 RCTs). Non-randomised studies will be considered if they adjust for key confounders (age and gender).</p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng217er13tab6"><div id="niceng217er13.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Summary of studies included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586314/table/niceng217er13.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er13.tab6_lrgtbl__"><table><thead><tr><th id="hd_h_niceng217er13.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng217er13.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Intervention and comparison</th><th id="hd_h_niceng217er13.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_niceng217er13.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er13.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er13.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Dwivedi 2017<a class="bibr" href="#niceng217er13.ref18" rid="niceng217er13.ref18"><sup>18</sup></a></p>
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<p>India</p>
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</td><td headers="hd_h_niceng217er13.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Resective surgery (n=57)</p>
|
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<p>Versus</p>
|
|
<p>Medical therapy whilst waiting for surgery (n=59)</p>
|
|
</td><td headers="hd_h_niceng217er13.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Children (median, range years)</p>
|
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<p>Surgery (9 years, 0.8 to 17 years)</p>
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<p>Waitlist (10 years, 2 to 17 years</p>
|
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</td><td headers="hd_h_niceng217er13.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">At 1 year:
|
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<ul><li class="half_rhythm"><div>Mortality</div></li><li class="half_rhythm"><div>Quality of life (Paediatric quality of life inventory scale)</div></li><li class="half_rhythm"><div>Seizure freedom</div></li><li class="half_rhythm"><div>Cognitive outcomes (Binet-Kamat scale)</div></li><li class="half_rhythm"><div>Social functioning</div></li><li class="half_rhythm"><div>Serious adverse events</div></li></ul></td><td headers="hd_h_niceng217er13.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_niceng217er13.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Engel 2012<a class="bibr" href="#niceng217er13.ref19" rid="niceng217er13.ref19"><sup>19</sup></a></p>
|
|
<p>USA</p>
|
|
</td><td headers="hd_h_niceng217er13.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Resective surgery (n=15)</p>
|
|
<p>Versus</p>
|
|
<p>Medical therapy (n=23)</p>
|
|
</td><td headers="hd_h_niceng217er13.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Children and young people (mean, (SD) years)</p>
|
|
<p>Surgery (37.5 years (11.1))</p>
|
|
<p>Waitlist (30.9 years, (10.1))</p>
|
|
</td><td headers="hd_h_niceng217er13.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">At 2 years:
|
|
<ul><li class="half_rhythm"><div>Quality of life (QOLIE-89 scale)</div></li><li class="half_rhythm"><div>Seizure freedom</div></li><li class="half_rhythm"><div>Seizure frequency</div></li><li class="half_rhythm"><div>Cognitive outcomes (Boston Naming Test, RAVLT delayed recall)</div></li><li class="half_rhythm"><div>Serious adverse events</div></li><li class="half_rhythm"><div>Healthcare resource use</div></li></ul></td><td headers="hd_h_niceng217er13.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_niceng217er13.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Wiebe 2001<a class="bibr" href="#niceng217er13.ref83" rid="niceng217er13.ref83"><sup>83</sup></a>; Fiest, 2014<a class="bibr" href="#niceng217er13.ref21" rid="niceng217er13.ref21"><sup>21</sup></a></p>
|
|
<p>USA</p>
|
|
</td><td headers="hd_h_niceng217er13.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Resective surgery (n=40)</p>
|
|
<p>Versus</p>
|
|
<p>Medical therapy whilst waiting for surgery (n=40)</p>
|
|
</td><td headers="hd_h_niceng217er13.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults (mean, (SD))</p>
|
|
<p>Surgery (35.5 years, (9.9))</p>
|
|
<p>Waitlist (34.4 years, (9.4))</p>
|
|
</td><td headers="hd_h_niceng217er13.tab6_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">At 1 year:
|
|
<ul><li class="half_rhythm"><div>Mortality</div></li><li class="half_rhythm"><div>Quality of life (QOLIE-89, QOLIE-31, HUI 111, SF36 PCS, SF36 MCS)</div></li><li class="half_rhythm"><div>Seizure freedom</div></li><li class="half_rhythm"><div>Serious adverse events</div></li></ul></td><td headers="hd_h_niceng217er13.tab6_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng217er13tab7"><div id="niceng217er13.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Clinical evidence summary: Surgery versus medical/ waitlist-control</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586314/table/niceng217er13.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er13.tab7_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng217er13.tab7_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng217er13.tab7_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng217er13.tab7_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng217er13.tab7_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng217er13.tab7_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng217er13.tab7_1_1_1_5" id="hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Waitlist-Control</th><th headers="hd_h_niceng217er13.tab7_1_1_1_5" id="hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Surgery (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mortality at 12-24 months</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>192</p>
|
|
<p>(2 studies)</p>
|
|
<p>1 year</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>RD −0.01</p>
|
|
<p>(−0.04 to 0.02)</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 per 1000</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>10 fewer per 1000</p>
|
|
<p>(from 40 fewer to 20 more)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Quality of life - Children</p>
|
|
<p>Paediatric QoL inventory scale. Scale from: 0 to 100.</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>116</p>
|
|
<p>(1 study)</p>
|
|
<p>1 year</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<sup>1</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean quality of life - children in the control groups was</p>
|
|
<p>53.9</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean quality of life - children in the intervention groups was</p>
|
|
<p>22.2 points higher</p>
|
|
<p>(16.38 to 28.02 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Quality of life - Adults</p>
|
|
<p>QOLIE-89 scale. Scale from: 0 to 100.</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>114</p>
|
|
<p>(2 studies)</p>
|
|
<p>1-2 years</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean quality of life - adults in the control groups was</p>
|
|
<p>64.45</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean quality of life - adults in the intervention groups was</p>
|
|
<p>9.67 points higher</p>
|
|
<p>(5.27 to 14.08 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Quality of life (change score)</p>
|
|
<p>QOLIE-89 cognitive scale. Scale from: 0 to 100.</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>38</p>
|
|
<p>(1 study)</p>
|
|
<p>2 years</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>VERY LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean quality of life (change score) in the control groups was</p>
|
|
<p>0.1</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean quality of life (change score) in the intervention groups was</p>
|
|
<p>7.7 higher</p>
|
|
<p>(1.03 to 14.37 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Quality of life.</p>
|
|
<p>QOLIE-89; Adjusted odds of achieving clinically significant improvement in QOLIE-89 (10.1 points) over 1 year period</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>76</p>
|
|
<p>(1 study)</p>
|
|
<p>1 year</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<sup>1</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adjusted OR: 15.1</p>
|
|
<p>(95% CI 2.7-84.8)</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not available</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD not calculable</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Quality of life.</p>
|
|
<p>QOLIE-31; Adjusted odds of achieving clinically significant improvement in QOLIE-31 (11.8 points) over 1 year period</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>76</p>
|
|
<p>(1 study)</p>
|
|
<p>1 year</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<sup>1</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adjusted OR: 15.2</p>
|
|
<p>(95% CI 2.6-88.0)</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not available</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD not calculable</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Quality of life.</p>
|
|
<p>HUI-111; Adjusted odds of achieving clinically significant improvement in HUI 111 (0.2 points) over 1 year period</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>76</p>
|
|
<p>(1 study)</p>
|
|
<p>1 year</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<sup>1</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adjusted OR: 6.0</p>
|
|
<p>(95% CI 1.7-21.5)</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not available</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD not calculable</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Quality of life.</p>
|
|
<p>SF-36 PCS; Adjusted odds of achieving clinically significant improvement in SF-36 PCS (4.6 point) over 1 year period</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>76</p>
|
|
<p>(1 study)</p>
|
|
<p>1 year</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adjusted OR: 2.4</p>
|
|
<p>(95% CI 1.0-5.8)</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not available</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD not calculable</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Quality of life.</p>
|
|
<p>SF-36 MCS; Adjusted odds of achieving clinically significant improvement in SF-36 MCS (3.0 points) over 1 year period</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>76</p>
|
|
<p>(1 study)</p>
|
|
<p>1 year</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adjusted OR: 2.5</p>
|
|
<p>(95% CI 1.0-6.6)</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not available</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD not calculable</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Seizure freedom: Hazard of first seizure<sup>*</sup></td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>230</p>
|
|
<p>(3 studies)</p>
|
|
<p>1 years</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>HR 0.29</p>
|
|
<p>(0.21 to 0.39)</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not available</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">RD not calculable</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Seizure freedom in second year of follow up</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>38</p>
|
|
<p>(1 study)</p>
|
|
<p>2 years</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<sup>1</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Peto OR 32.19</p>
|
|
<p>(7.82 to 132.54)</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>730 more per 1000</p>
|
|
<p>(from 510 more to 960 more)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Seizure frequency at 22 to 24 months</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>32</p>
|
|
<p>(1 study)</p>
|
|
<p>2 years</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean seizure frequency in the control groups was</p>
|
|
<p>9.47</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean seizure frequency in the intervention groups at 22 to 24 months was</p>
|
|
<p>9.16 lower</p>
|
|
<p>(19.1 lower to 0.78 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cognitive outcomes Binet-Kamat test</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>116</p>
|
|
<p>(1 study)</p>
|
|
<p>1 year</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">HIGH</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean cognitive outcomes in the control groups was</p>
|
|
<p>58.9</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean cognitive outcomes in the intervention groups was</p>
|
|
<p>3.8 higher</p>
|
|
<p>(3.61 lower to 11.21 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cognitive outcomes (change score) Boston Naming Test</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>38</p>
|
|
<p>(1 study)</p>
|
|
<p>2 years</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean cognitive outcomes (change score) in the control groups was</p>
|
|
<p>0.8</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean cognitive outcomes (change score) in the intervention groups was</p>
|
|
<p>4.2 lower</p>
|
|
<p>(8.43 lower to 0.03 higher)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cognitive outcomes (change score) RAVLT delayed recall</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>38</p>
|
|
<p>(1 study)</p>
|
|
<p>2 years</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean cognitive outcomes (change score) in the control groups was</p>
|
|
<p>0.6</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean cognitive outcomes (change score) in the intervention groups was</p>
|
|
<p>2.1 lower</p>
|
|
<p>(4.1 to 0.1 lower)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Social functioning Child behaviour Checklist. Scale from: 0 to 100.</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>116</p>
|
|
<p>(1 study)</p>
|
|
<p>1 year</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<sup>1</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean social functioning in the control groups was</p>
|
|
<p>68.6</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean social functioning in the intervention groups was</p>
|
|
<p>11.4 lower</p>
|
|
<p>(14.01 to 8.79 lower)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious adverse events</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>230</p>
|
|
<p>(3 studies)</p>
|
|
<p>1-2 years</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>MODERATE<sup>1</sup></p>
|
|
<p>due to risk of bias</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Peto OR RR 7.30</p>
|
|
<p>(3.41 to 15.61)</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33 per 1000</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">230 more per 1000 (from 140 more to 320 more)</td></tr><tr><td headers="hd_h_niceng217er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Number of AEDs used</td><td headers="hd_h_niceng217er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>38</p>
|
|
<p>(1 study)</p>
|
|
<p>2 years</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>LOW<sup>1</sup><sup>,</sup><sup>2</sup></p>
|
|
<p>due to risk of bias, imprecision</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean number of AEDs used in the control groups was</p>
|
|
<p>1.8</p>
|
|
</td><td headers="hd_h_niceng217er13.tab7_1_1_1_5 hd_h_niceng217er13.tab7_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>The mean number of AEDs used in the intervention groups was</p>
|
|
<p>0.30 lower</p>
|
|
<p>(0.84 lower to 0.24 higher)</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng217er13.tab7_1"><p class="no_margin">Downgraded by 1 increment if the majority of the evidence was at high risk of bias, and downgraded by 2 increments if the majority of the evidence was at very high risk of bias</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng217er13.tab7_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl><dl class="bkr_refwrap"><dt>*</dt><dd><div id="niceng217er13.tab7_3"><p class="no_margin">Hazard is for first seizure, so a lower hazard represents a benefit; thus, a HR <1 indicates a benefit for surgery</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er13tab8"><div id="niceng217er13.tab8" class="table"><h3><span class="label">Table 8</span><span class="title">Health economic evidence profile: Testing strategies following discordant EEG and MRI findings versus medical management</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586314/table/niceng217er13.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er13.tab8_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er13.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng217er13.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Applicability</th><th id="hd_h_niceng217er13.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Limitations</th><th id="hd_h_niceng217er13.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Other comments</th><th id="hd_h_niceng217er13.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental cost</th><th id="hd_h_niceng217er13.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental effects</th><th id="hd_h_niceng217er13.tab8_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Cost effectiveness</th><th id="hd_h_niceng217er13.tab8_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Uncertainty</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er13.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Burch 2012<a class="bibr" href="#niceng217er13.ref10" rid="niceng217er13.ref10"><sup>10</sup></a> & Hinde 2014<a class="bibr" href="#niceng217er13.ref23" rid="niceng217er13.ref23"><sup>23</sup></a> (United Kingdom)</td><td headers="hd_h_niceng217er13.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Partially applicable<sup>(a)</sup></td><td headers="hd_h_niceng217er13.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Minor limitations<sup>(b)</sup></td><td headers="hd_h_niceng217er13.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Probabilistic decision analytic model. Decision tree followed by Markov model.</div></li><li class="half_rhythm"><div>Cost-utility analysis (QALYs)</div></li><li class="half_rhythm"><div>Population: Medically refractory epileptic patients with TLE who have had discordant findings from initial video-EEG and MRI scans.</div></li><li class="half_rhythm"><div>Comparators:
|
|
<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1)</dt><dd><p class="no_top_margin">Medical Management (MM)</p></dd></dl><dl class="bkr_refwrap"><dt>2)</dt><dd><p class="no_top_margin">FDG-PET. If positive result offered surgery, if negative or uncertain offered MM</p></dd></dl><dl class="bkr_refwrap"><dt>3)</dt><dd><p class="no_top_margin">FDG-PET. If positive result, offered surgery, if negative, MM, if uncertain, iEEG (if positive, offered surgery, otherwise MM)</p></dd></dl></dl></div></li></ul>
|
|
Time horizon: lifetime</td><td headers="hd_h_niceng217er13.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>(2-1)</p>
|
|
<p>£2,845</p>
|
|
<p>(3-1)<sup>(c)</sup></p>
|
|
<p>£3,927</p>
|
|
</td><td headers="hd_h_niceng217er13.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>(2-1)</p>
|
|
<p>1.71 QALYs</p>
|
|
<p>(3-1)<sup>(c)</sup></p>
|
|
<p>2.04</p>
|
|
</td><td headers="hd_h_niceng217er13.tab8_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<b>Intervention 2 vs. 1:</b>
|
|
</p>
|
|
<p>£1,671 per QALY gained</p>
|
|
<p>
|
|
<b>Intervention 3 vs. 1:</b>
|
|
<sup>
|
|
(c)
|
|
</sup>
|
|
</p>
|
|
<p>£1,925 per QALY gained</p>
|
|
</td><td headers="hd_h_niceng217er13.tab8_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Probability Intervention 1 cost effective (£20/£30K threshold): 14%/13%</p>
|
|
<p>Probability Intervention 2 cost effective (£20/£30K threshold): 3%/3%</p>
|
|
<p>MM and surgery outcomes equivalent after 1 year - both strategies remained cost effective (ICER 2 = £11,536; ICER 3<sup>(c)</sup> = £13,794).</p>
|
|
<p>PSA indicated that the disutility of Disabling Seizure for MM and surgery (no complications) had the potential to alter results; but strategy 3 was still the most cost effective in the majority of cases (0.85 and 0.93, respectively)</p>
|
|
<p>The results became more sensitive to the short-term effectiveness of surgery, whereby if the success rate of surgery is < 55% then Strategy 1 would be most cost effective.</p>
|
|
<p>Conclusion from base case and the scenario analysis would change if compliance to surgery was < 20%.</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Abbreviations DS= disabling seizure; EEG= electroencephalography; FDG-PET= fluorodeoxyglucose positron emission tomography; ICER= incremental cost-effectiveness ratio; iEEG= invasive/intracranial electroencephalography; MM= medical management; MRI= magnetic resonance imaging; PSA= probabilistic sensitivity analysis; QALY= quality-adjusted life years; TLE= temporal lobe epilepsy</p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng217er13.tab8_1"><p class="no_margin">Study evaluates the cost effectiveness of different diagnostic strategies for potential patients undergoing TLE surgery. The diagnostic testing strategies used to identify eligible patients may not reflect those used in current practice.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="niceng217er13.tab8_2"><p class="no_margin">Some simplifying assumptions are made due to lack of evidence available. In some instances, it is not apparent what timeframe is being analysed in evidence drawn from the wider literature used to inform model parameters. Treatment effects based on a mix of RCTs and observational data</p></div></dd></dl><dl class="bkr_refwrap"><dt>(c)</dt><dd><div id="niceng217er13.tab8_3"><p class="no_margin">Calculated from paper. The paper compares strategy 3 vs. 2 but we are interested in 3 vs. 1 so we can compare the different diagnostic strategies to medical management.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng217er13tab9"><div id="niceng217er13.tab9" class="table"><h3><span class="label">Table 9</span><span class="title">Health economic evidence profile: Intracranial EEG (subdural grid electrodes) versus iEEG (stereoelectroencephalography) versus medical management</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586314/table/niceng217er13.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er13.tab9_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng217er13.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng217er13.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Applicability</th><th id="hd_h_niceng217er13.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Limitations</th><th id="hd_h_niceng217er13.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Other comments</th><th id="hd_h_niceng217er13.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental cost</th><th id="hd_h_niceng217er13.tab9_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental effects</th><th id="hd_h_niceng217er13.tab9_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Cost effectiveness</th><th id="hd_h_niceng217er13.tab9_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Uncertainty</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er13.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Kovacs 2021<a class="bibr" href="#niceng217er13.ref29" rid="niceng217er13.ref29"><sup>29</sup></a> (Hungary)</td><td headers="hd_h_niceng217er13.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Partially applicable<sup>(a)</sup></td><td headers="hd_h_niceng217er13.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Minor limitations<sup>(b)</sup></td><td headers="hd_h_niceng217er13.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Probabilistic decision analytic model. Decision tree followed by Markov model.</div></li><li class="half_rhythm"><div>Cost-utility analysis (QALYs)</div></li><li class="half_rhythm"><div>Population: Adults with drug-resistant, partial-onset epilepsy.</div></li><li class="half_rhythm"><div>Comparators:
|
|
<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1)</dt><dd><p class="no_top_margin">Medical Management (MM)</p></dd></dl><dl class="bkr_refwrap"><dt>2)</dt><dd><p class="no_top_margin">intracranial EEG (iEEG) monitoring: placement of subdural grid electrodes (SDGs)</p></dd></dl><dl class="bkr_refwrap"><dt>3)</dt><dd><p class="no_top_margin">iEEG: stereotactic implantation of depth electrodes (stereoelectroencephalo graphy or SEEG).</p></dd></dl></dl>
|
|
<ul class="simple-list"><li class="half_rhythm"><div>After either iEEG, if successful epileptogenic zone localisation they are offered surgery (temporal or extratemporal resective surgery). If unsuccessful offered MM.</div></li></ul></div></li></ul>
|
|
Time horizon: 30 years</td><td headers="hd_h_niceng217er13.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>(2-1)</p>
|
|
<p>£9,647</p>
|
|
<p>(3-1)<sup>(c)</sup></p>
|
|
<p>£16,837</p>
|
|
</td><td headers="hd_h_niceng217er13.tab9_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>(2-1)</p>
|
|
<p>3.444 QALYs</p>
|
|
<p>(3-1)<sup>(c)</sup></p>
|
|
<p>3.931</p>
|
|
</td><td headers="hd_h_niceng217er13.tab9_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>
|
|
<b>Intervention 2 vs. 1:</b>
|
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</p>
|
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<p>£2,802 per QALY gained</p>
|
|
<p>
|
|
<b>Intervention 3 vs. 1:</b>
|
|
</p>
|
|
<p>£4,284 per QALY gained</p>
|
|
</td><td headers="hd_h_niceng217er13.tab9_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Probability Intervention 2 cost effective (£38K threshold): 99.7%</p>
|
|
<p>Probability Intervention 3 cost effective (£38K threshold): 99.5%</p>
|
|
<p>One-way sensitivity and scenario analyses undertaken. None of these deterministic sensitivity analyses lead to a substantial change in ICER or resulted in an ICER over £38K.</p>
|
|
</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Abbreviations DS= disabling seizure; ICER= incremental cost-effectiveness ratio; iEEG= invasive/intracranial electroencephalography; MM= medical management; PSA= probabilistic sensitivity analysis; QALY= quality-adjusted life years; SDGs= subdural grid electrodes; SEEG= stereoelectroencephalography</p></div></dd></dl><dl class="bkr_refwrap"><dt>(a)</dt><dd><div id="niceng217er13.tab9_1"><p class="no_margin">Study evaluates the cost effectiveness of different diagnostic strategies for potential patients undergoing temporal or extratemporal resective surgery. The diagnostic testing strategies used to identify eligible patients may not reflect those used in current practice. Non-UK perspective may not reflect current UK NHS practice. EQ-5D not used for QoL.</p></div></dd></dl><dl class="bkr_refwrap"><dt>(b)</dt><dd><div id="niceng217er13.tab9_2"><p class="no_margin">Unclear if literature used to inform model parameters were appropriate for this subset of patients who would undergo iEEG diagnostic procedures prior to surgery. Treatment effects based on a mix of RCTs and observational data. Not all data sources clearly reported.</p></div></dd></dl></dl></div></div></div></article><article data-type="fig" id="figobniceng217er13fig1"><div id="niceng217er13.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Decision%20tree.&p=BOOKS&id=586314_niceng217er13f1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK586314/bin/niceng217er13f1.jpg" alt="Figure 1. Decision tree." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Decision tree</span></h3></div></article><article data-type="fig" id="figobniceng217er13fig2"><div id="niceng217er13.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20Markov%20model.&p=BOOKS&id=586314_niceng217er13f2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK586314/bin/niceng217er13f2.jpg" alt="Figure 2. Markov model." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">Markov model</span></h3></div></article><article data-type="table-wrap" id="figobniceng217er13tab10"><div id="niceng217er13.tab10" class="table"><h3><span class="label">Table 10</span><span class="title">Preoperative assessment cost</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586314/table/niceng217er13.tab10/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er13.tab10_lrgtbl__"><table><thead><tr><th id="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Test</th><th id="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mean number of tests (n=762)</th><th id="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">Unit cost</th><th id="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">Mean cost per patient investigated</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">History & Examination</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.4</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£217</td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£315</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Neuropsychology assessment</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.9</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£334</td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£291</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Neuropsychiatry assessment</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.5</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£346</td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£157</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetic resonance imaging (MRI)</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.6</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£146</td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£234</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Initial videotelemetry</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.9</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£2,791</td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£2,630</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Repeat videotelemetry</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.3</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£2,791</td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£736</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Positron emission tomography (PET)</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.4</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£666</td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£270</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Occupational therapy</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.0052</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£111</td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£0.58</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Physiotherapy</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.0052</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£59</td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£0.31</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Stereoelectroencephalography (sEEG)</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.2</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£14,638</td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£2,497</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Single-photon emission computed tomography (SPECT)</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.1</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£342</td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£31</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Functional magnetic resonance imaging (fMRI)</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.4</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£146<sup>(a)</sup></td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£55</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Amytal testing</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.0354</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£3,545<sup>(b)</sup></td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£126</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Magnetoencephalography (MEG)</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.0197</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£3,250<sup>(c)</sup></td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£64</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Multidisciplinary team meeting</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.6</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£226</td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£362</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pre-surgical counselling</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.7</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£346</td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£235</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Informed consent assessment</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.4</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£224</td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£83</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Electrocochleography (ECoG)</td><td headers="hd_h_niceng217er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.0236</td><td headers="hd_h_niceng217er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£4,000<sup>(d)</sup></td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£94</td></tr><tr><td headers="hd_h_niceng217er13.tab10_1_1_1_1 hd_h_niceng217er13.tab10_1_1_1_2 hd_h_niceng217er13.tab10_1_1_1_3" colspan="3" rowspan="1" style="text-align:left;vertical-align:top;">
|
|
<b>Total cost</b>
|
|
</td><td headers="hd_h_niceng217er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">
|
|
<b>£8,182</b>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng217er13tab11"><div id="niceng217er13.tab11" class="table"><h3><span class="label">Table 11</span><span class="title">Base case cost effectiveness results (probabilistic)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586314/table/niceng217er13.tab11/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er13.tab11_lrgtbl__"><table><thead><tr><th id="hd_h_niceng217er13.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Year</th><th id="hd_h_niceng217er13.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgery</th><th id="hd_h_niceng217er13.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Medical management</th><th id="hd_h_niceng217er13.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Surgery minus Medical management</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er13.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mean costs</td><td headers="hd_h_niceng217er13.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£56,204</td><td headers="hd_h_niceng217er13.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£31,627</td><td headers="hd_h_niceng217er13.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£24,577</td></tr><tr><td headers="hd_h_niceng217er13.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mean QALYs</td><td headers="hd_h_niceng217er13.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.91</td><td headers="hd_h_niceng217er13.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.76</td><td headers="hd_h_niceng217er13.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.15</td></tr><tr><td headers="hd_h_niceng217er13.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incremental cost per QALY gained</td><td headers="hd_h_niceng217er13.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_niceng217er13.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td><td headers="hd_h_niceng217er13.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£11,425</td></tr><tr><td headers="hd_h_niceng217er13.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Probability cost-effective at £20,000 per QALY</td><td headers="hd_h_niceng217er13.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">96.5%</td><td headers="hd_h_niceng217er13.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.5%</td><td headers="hd_h_niceng217er13.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr><tr><td headers="hd_h_niceng217er13.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Probability cost-effective at 30,000 per QALY</td><td headers="hd_h_niceng217er13.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">99.3%</td><td headers="hd_h_niceng217er13.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.7%</td><td headers="hd_h_niceng217er13.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng217er13tab12"><div id="niceng217er13.tab12" class="table"><h3><span class="label">Table 12</span><span class="title">Sensitivity analysis (deterministic)</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK586314/table/niceng217er13.tab12/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng217er13.tab12_lrgtbl__"><table><thead><tr><th id="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Scenario</th><th id="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:bottom;">Incremental costs</th><th id="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:bottom;">Incremental QALYs</th><th id="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:bottom;">Incremental cost per QALY gained</th></tr></thead><tbody><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Determinist base case</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£23,601</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2.13</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£11,069</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Probabilistic base case</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£24,577</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2.15</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£11,425</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Utilities assuming 50% of people in the surgery arm have a ≥50% reduction in seizures</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£23,601</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2.30</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£10,277</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Utilities from Kovacs 2021</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£23,601</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">3.03</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£7,780</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Utilities from the previous NICE guidance</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£23,601</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">1.32</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£17,821</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The probability of receiving surgery is higher</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£17,427</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2.13</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£8,174</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The probability of receiving surgery is lower</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£35,259</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2.13</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£16,537</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Treatment effect from Wiebe 2001 only</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£23,731</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2.10</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£11,314</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">SMR for seizure free is 1.11</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£23,724</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2.34</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£10,158</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgery relapse rate higher</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£24,601</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">1.95</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£12,608</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgery relapse rate lower</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£22,472</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2.33</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£9,630</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Assessment for resective surgery costs higher</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£35,878</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2.13</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£16,827</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Assessment for resective surgery costs lower</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£16,948</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2.13</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£7,949</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgery costs higher</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£29,783</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2.13</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£13,969</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgery costs lower</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£21,726</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2.13</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£10,190</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Time horizon 15 years</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£26,979</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.96</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£28,231</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No discontinuation of anti-seizure medications</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£29,852</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2.13</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£14,001</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Higher cost for sEEG</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£27,783</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">2.13</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£13,031</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Overall best case</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£9,931</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">3.53</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£2,811</td></tr><tr><td headers="hd_h_niceng217er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Overall worst case</td><td headers="hd_h_niceng217er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£66,725</td><td headers="hd_h_niceng217er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">0.37</td><td headers="hd_h_niceng217er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:right;vertical-align:top;">£182,331</td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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