{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T17:29:32Z","timestamp":1788370172535,"version":"build-2803163510"},"reference-count":30,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2022,3,13]],"date-time":"2022-03-13T00:00:00Z","timestamp":1647129600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Refractory epilepsy is a diagnosis of recurrent seizures that requires multiple resources for optimal chronic management. The disease negatively impacts the lives of affected patients and families and poses an economic burden to the health care system. This study compares hospital costs between pediatric patients treated with antiseizure medications (ASMs) only and ASMs plus vagus nerve stimulation (VNS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients 0\u201317\u00a0years of age who were diagnosed with refractory epilepsy between January 1, 2011 and December 31, 2016, were identified from the Children's Hospital Association's Pediatric Health Information System (PHIS) database. Patients treated with ASMs only or ASMs plus VNS were included in the study and were followed 1\u00a0year prior and 2\u00a0years after meeting pre\u2010determined criteria for refractory epilepsy. The difference\u2010in\u2010difference (DID) approach along with the two\u2010part model was used to compare the changes in mean hospital costs captured in the PHIS database over time between the two cohorts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One thousand one hundred thirteen patients treated with ASMs plus VNS and 3471 patients treated with ASMs only were included. At a follow\u2010up time of 2\u00a0years, for the ASMs\u2010only cohort, the adjusted all\u2010cause and epilepsy\u2010related mean annual total costs increased by $14\u00a0715 (95% confidence interval [CI]: $12\u00a0375\u2013$17\u00a0055) and $18\u00a0437 (95% CI: $15\u00a0978\u2013$20\u00a0896), respectively. By comparison, the adjusted all\u2010cause and epilepsy\u2010related mean annual total costs of the ASMs plus VNS cohort increased by $12\u00a0838 (95% CI: $8171\u2013$17\u00a0505) and $15\u00a0183 (95% CI: $10\u00a0253\u2013$20\u00a0113), respectively. Compared to ASMs only, ASMs plus VNS generated a cost savings of $3254 for epilepsy\u2010related annual costs per year after the index date.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>Compared to ASMs alone, ASMs plus VNS is a treatment modality associated with lower annual hospital costs over time. Our study shows that VNS is a cost\u2010beneficial treatment for a national cohort of pediatric patients with refractory epilepsy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.17208","type":"journal-article","created":{"date-parts":[[2022,2,21]],"date-time":"2022-02-21T16:54:41Z","timestamp":1645462481000},"page":"1141-1151","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Hospital costs associated with vagus nerve stimulation and\u00a0medical treatment in pediatric patients with refractory\u00a0epilepsy"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0787-2595","authenticated-orcid":false,"given":"Lu","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Neurological Surger Northwestern University Feinberg School of Medicine  Chicago Illinois USA"},{"name":"Division of Pediatric Neurosurgery Ann &amp; Robert Lurie Children's Hospital of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7778-5887","authenticated-orcid":false,"given":"Matt","family":"Hall","sequence":"additional","affiliation":[{"name":"Data and Biostatistics Children's Hospital Association  Lenexa Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3294-6637","authenticated-orcid":false,"given":"Sandi K.","family":"Lam","sequence":"additional","affiliation":[{"name":"Department of Neurological Surger Northwestern University Feinberg School of Medicine  Chicago Illinois USA"},{"name":"Division of Pediatric Neurosurgery Ann &amp; Robert Lurie Children's Hospital of Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,3,13]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Epilepsy : Frequency, Causes and Consequences","author":"Hauser WA","year":"1990"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1989.tb05289.x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-1371"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12179"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2014.01.016"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13084"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.45.2.224"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182a393d1"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-200012000-00016"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2015.02.009"},{"key":"e_1_2_9_12_1","first-page":"9709056","article-title":"Neuromodulation therapy with vagus nerve stimulation for intractable epilepsy: a 2\u2010year efficacy analysis study in patients under 12 years of age","volume":"2016","author":"Suresh G","year":"2016","journal-title":"Epilepsy Res Treat"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2006.06.002"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2008.01940.x"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.3171\/2011.2.PEDS10505"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0920-1211(01)00286-8"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpn.2012.01.001"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/0883073817743639"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2014.10.014"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13001"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12912"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02201.x"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.3171\/FOC\/2008\/25\/9\/E10"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.2329"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-14-199"},{"key":"e_1_2_9_26_1","unstructured":"WooldridgeJ.Difference\u2010in\u2010Differences Estimation;2007[Available from:https:\/\/www.nber.org\/WNE\/lect_10_diffindiffs.pdf. 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