Economic aspects of prolonged home video-EEG monitoring: a simulation study

Abstract Introduction Video EEG monitoring (VEM) is an important tool to characterize clinical events suspected as seizures. It is also used for pre-surgical workup in patients with drug-resistant epilepsy (DRE). The high cost and inconvenience of in-hospital VEM led to interest in home VEM (HVEM). However, because antiseizure medications cannot be reduced at home, HVEM may require longer monitoring. While the economic aspect is one of the main motivations for HVEM, the cost of HVEM lasting several weeks has not been assessed. Methods We modeled the cost of HVEM during eight weeks and compared it to the cost of one-week in-hospital VEM. Additionally, we modeled the per-patient cost for a combination of HVEM and in-hospital VEM, considering that if in a proportion of patients HVEM fails to achieve its goal, they should undergo in-hospital VEM with drug reduction. Results The average cost of HVEM up to 4–6 weeks of monitoring was lower than that for the one-week in-hospital VEM. The combination of the three-week HVEM with one-week in-hospital VEM (if needed) reduced the per-patient cost by 6.6–28.6% as compared to the situation when all the patients with DRE were referred to the in-hospital VEM. Conclusions A prolonged intermittent HVEM can be economically efficient, which justifies directing the efforts into clinical trials and technology development.