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Healthcare utilization and costs after cranial epilepsy surgery and vagus nerve stimulation in pediatric drug-resistant epilepsy: a nationwide cohort study

Arum Choi,Sukil Kim,Jooyoung Lee

Published 2025 in Scientific Reports

ABSTRACT

Pediatric drug-resistant epilepsy (DRE) affects 30–40% of children with epilepsy, resulting in medical costs significantly higher than those of controlled epilepsy. Cranial epilepsy surgery (CES) and vagus nerve stimulation (VNS) are key interventions; however, their long-term economic impact remains ambiguous. Using South Korea’s National Health Insurance claims data (2007–2022), we examined healthcare utilization and costs among children with DRE treated with antiseizure medications (ASM) only, CES, or VNS. Of the cohort included 6020 patients, of whom 5407 (89.8%) received ASM-only treatment, 396 (6.6%) underwent CES, and 217 (3.6%) received VNS. Post-CES, emergency department (ED) visits declined by 65%, overall length of stay (LOS) by 45%, epilepsy-specific admissions by 49% and epilepsy-specific LOS by 83%. Interrupted time series analysis revealed a sustained monthly reduction in total costs, consistent with fewer high-risk encounters. Post-VNS, ED visits fell by 41%, admissions by 39%, and LOS by 44%, with reductions in epilepsy-related admissions; however, outpatient visits remained unchanged. Both CES and VNS significantly reduce acute-care needs in pediatric DRE. CES yields the greatest and most durable benefits, while VNS shifts care from emergency and inpatient settings to scheduled outpatient follow-up, offering a valuable alternative when surgery is not feasible.

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