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

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.