BACKGROUND Pediatric refractory epilepsy affects quality of life, clinical disability, and healthcare costs for patients and families. OBJECTIVE To show the impact of surgical treatment for pediatric epilepsy on healthcare utilization compared to medically treated pediatric epilepsy over 5 yr. METHODS The Pediatric Health Information System database was used to conduct a cohort study using 5 published algorithms. Refractory epilepsy patients treated with antiepileptic medications (AEDs) only or AEDs plus epilepsy surgery between 1/1/2008 and 12/31/2014 were included. Healthcare utilization following the index date at 2 and 5 yr including inpatient, emergency department (ED), and all epilepsy-related visits were evaluated. The propensity scores (PS) method was used to match surgically and medically treated patients. PS. SAS® 9.4 and Stata 14.0 were used for data management and statistical analysis. RESULTS A total of 2106 (17.1%) and 10186 (82.9%) were surgically and medically treated. A total of 4050 matched cases, 2025 per each treated group, were included. Compared to medically treated patients, utilization was reduced in the surgical group: at 2 and 5 yr postindex date, there was a reduction of 36% to 37% of inpatient visits and 47% to 50% of ED visits. The total number (inpatient, ED, ambulatory visits) of epilepsy-associated visits were reduced by 39% to 43% in the surgical group compared to the medically treated group. In those who had surgery, the average reduction in AEDs was 16% at 2 and 5 yr after treatment. CONCLUSION Patients with refractory epilepsy treated with surgery had significant reductions in healthcare utilization compared with patients treated only with medications.

中文翻译：

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儿童难治性癫痫内科和外科治疗的有效性

背景小儿难治性癫痫影响患者和家庭的生活质量、临床残疾和医疗保健费用。目的 与超过 5 年的药物治疗小儿癫痫相比，显示手术治疗小儿癫痫对医疗保健利用的影响。方法 儿科健康信息系统数据库用于使用 5 种已发表的算法进行队列研究。包括在 2008 年 1 月 1 日至 2014 年 12 月 31 日期间仅使用抗癫痫药物 (AED) 或 AED 加癫痫手术治疗的难治性癫痫患者。评估了第 2 年和第 5 年索引日期后的医疗保健利用率，包括住院、急诊科 (ED) 和所有与癫痫相关的就诊。倾向评分 (PS) 方法用于匹配接受手术和药物治疗的患者。附注。SAS® 9.4 和 Stata 14。0 用于数据管理和统计分析。结果 共有 2106 例（17.1%）和 10186 例（82.9%）接受了手术和药物治疗。总共包括 4050 个匹配的病例，每个治疗组 2025 个。与接受药物治疗的患者相比，手术组的利用率降低：在指标后第 2 年和第 5 年，住院就诊次数减少了 36% 至 37%，急诊就诊次数减少了 47% 至 50%。与药物治疗组相比，手术组癫痫相关就诊的总次数（住院、急诊、门诊就诊）减少了 39% 至 43%。在接受手术的患者中，治疗后 2 年和 5 年的 AED 平均降低了 16%。