1041 Cost-Effectiveness Analysis of Laser Interstitial Thermal Therapy Versus Treatment as Usual for Mesial Temporal Lobe Epilepsy

INTRODUCTION: Laser Interstitial Thermal Therapy (LITT) has emerged as an effective, minimally invasive alternative to conventional resective surgery for managing mesial temporal lobe epilepsy (mTLE). As LITT enables precise targeting of the epileptic zone, its adoption in clinical practice has increased. Given its expanding use, it is paramount to address whether LITT not only provides clinical benefits but also offers a cost-effective solution compared to treatment as usual (TAU) management with antiepileptic drugs. METHODS: Using decision analytics models, we compared the cost-effectiveness of LITT to TAU over one- and two-year horizons. Costs were approached from the healthcare sector perspective, drawn from Medicare reimbursement rates and Current Procedural Terminology (CPT) codes. For each model, a Monte Carlo simulation (n = 100,000) and probabilistic sensitivity analysis were performed to estimate the Net Monetary Benefit (NMB) in USD ($) for each intervention. RESULTS: We included published data from 70 mTLE patients who received LITT with outcomes at one year and 41 patients with outcomes at two years. The cost-effectiveness analysis demonstrated a NMB of $30,808.59 for LITT and $11,303.29 for TAU at one year. At two years, the NMB was $28,658.87 for LITT and -$14,363.61 for TAU. At a conservative willingness-to-pay (WTP) threshold of $50,000/QALY, LITT was more cost-effective than TAU in 62% and 95% of iterations at one and two years, respectively. Using a modern WTP threshold of $100,000/QALY, LITT was more cost-effective in 79% and 95% of iterations at one and two years. CONCLUSIONS: LITT is more cost-effective than TAU for mTLE over one and two years. However, further research is needed to validate these findings and determine its long-term utility and potential to decrease monetary burden.