An economic evaluation of the NightWatch for children with refractory epilepsy: insight into the cost-effectiveness and cost-utility

Abstract

Introduction

We performed an economic evaluation, from a societal perspective, to examine the cost-utility and cost-effectiveness of a wearable multimodal seizure detection device: NightWatch.

Methods We collected data from the PROMISE study (NCT03909984), including children aged 4-16 years with refractory epilepsy living at home. Caregivers completed questionnaires on stress (Caregiver Strain Index), quality of life (EQ-5D-5L), health care consumption and productivity costs after the two-month baseline and the two-month intervention period with NightWatch. We used costs, stress levels and quality-adjusted life years (QALYs) to calculate incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves using bootstrapping. Missing items was handled with mean imputation. Three univariate sensitivity analyses examined the robustness of the results. Results We included 41 children (18% female; mean age 9.8 years). We observed a decrease in mean costs of €775 during the intervention, compared to baseline. The QALYs were similar between both periods, yet at a ceiling ratio of €50,000, NightWatch showed a 72% cost-effective probability. Of the bootstrapped ICERs of the CSI, 82% lay in the dominant southeast quadrant (i.e., cost-effective). Univariate sensitivity analysis demonstrated result robustness. Conclusions Our study shows that NightWatch may be a cost-effective addition to current standard care for children with refractory epilepsy living at home.