VNS Therapy Achieves Cost Neutrality Within 2 Years Across All US Payer Types

VNS Therapy implantation (LivaNova, London, United Kingdom) reduced healthcare utilization and costs for individuals with drug-resistant epilepsy (DRE) across commercial (COM), Medicare (MCARE), and Medicaid (MCAID) insurance populations, with cost neutrality achieved within 1.5 to 2 years post-implantation, according to findings presented at the 2025 American Epilepsy Society (AES) Annual Meeting.

The retrospective analysis utilized data from Merative MarketScan (Ann Arbor, MI) and the US Centers for Medicare and Medicaid Services (CMS) to identify 6121 individuals with DRE who underwent VNS Therapy implantation in COM (n=659), MCARE (n=3115), and MCAID (n=2347) populations. Researchers excluded individuals without an epilepsy diagnosis on the index date, those without antiseizure medication (ASM) claims in the year before implantation, and individuals with less than 2 years of continuous enrollment immediately before indexing. Using regression models based on 2-year pre-implantation healthcare resource utilization and pharmacotherapy, researchers estimated expected values over the 24-month post-index period and compared observed outcomes on both all-cause and epilepsy-related bases.

Key findings included:

• VNS implantation reduced overall DRE burden, including all-cause and epilepsy-related healthcare utilization and costs.
• Mean healthcare costs were lower than expected for all 23 months post-implantation, except for the index month.
• Observed and expected total costs were comparable by months 17 to 20, suggesting cost neutrality within 1.5 to 2 years.
• Results were consistent across all three insurance populations (COM, MCARE, and MCAID), with similar reductions in hospitalizations and emergency department (ED) visits.
• The cost of VNS Therapy was offset by savings in other healthcare resources within 2 years, primarily through reductions in hospitalization.

The consistency of findings across different payer types strengthens real-world evidence supporting VNS Therapy benefits for individuals with DRE and may inform coverage decisions across commercial and government insurance programs.

Source: Evans K, Berger A, Li Q, et al. Healthcare services and costs 2-years pre- and post-VNS therapy implantation across US payer types (commercial, Medicare, and Medicaid). Presented at: American Epilepsy Society Annual Meeting; December 5–9, 2025; Atlanta, GA.