Cost‐effectiveness of laser interstitial thermal therapy vs. anterior temporal lobectomy for drug‐resistant mesial temporal lobe epilepsy: A decision analytic model

Abstract Objective To evaluate the comparative cost‐effectiveness of anterior temporal lobectomy (ATL) and magnetic resonance–guided laser interstitial thermal therapy (LITT) in patients with drug‐resistant mesial temporal lobe epilepsy (mTLE). Methods A decision‐analytic model was constructed to simulate the risks, benefits, and costs of ATL versus LITT over a 1‐year time horizon from a healthcare system perspective. Model inputs, including seizure freedom rates, complication probabilities, and cost estimates, were derived from recent meta‐analyses and published cost comparison studies. The main outcome measure was the probability of a positive outcome, which was defined as seizure freedom without major complication. Incremental cost‐effectiveness ratios (ICERs) were calculated, and both one‐way and two‐way sensitivity analyses were conducted to assess parameter uncertainty. Results In the base‐case analysis, ATL achieved a 61% probability of a positive outcome compared with 55% for LITT. The mean per‐patient cost was $145 847 for ATL and $108 730 for LITT, resulting in an incremental cost of $37 117. Although ATL provided a modest 6% absolute increase in favorable outcomes, the ICER was $574 521 per additional positive outcome gained relative to LITT. Sensitivity analyses demonstrated that LITT remained the more cost‐effective option under most plausible parameter values, with ATL becoming favorable only under conditions of unusually high seizure freedom and low complication rates. Significance Although ATL yields slightly superior seizure outcomes, its substantially higher costs render LITT the more cost‐effective strategy for drug‐resistant mTLE at a 1‐year horizon. These findings support the growing role of minimally invasive techniques in epilepsy surgery, though further real‐world and long‐term data are needed to confirm the durability of LITT's clinical and economic benefits. Plain Language Summary This study compared two surgical treatments for drug‐resistant mesial temporal lobe epilepsy: anterior temporal lobectomy (ATL) and laser interstitial thermal therapy (LITT). Using a decision‐analytic model over 1 year, ATL showed slightly better seizure outcomes but at a substantially higher cost. Overall, LITT was more cost‐effective in most scenarios due to lower costs and fewer complications. These findings suggest that LITT may offer a practical and economically favorable option for many patients, although treatment decisions should still consider individual clinical factors.