Background: Children with pharmacoresistant epilepsy usually receive ketogenic diet (KD) as an inpatient, which makes it an expensive treatment. Objective: To compare the effectiveness, safety, and costs of outpatient versus inpatient initiated KD. Design: Retrospective observational non-inferiority study. Patients/setting: Patients (1–18 years of age) who started KD either inpatient or outpatient. Main outcome measures: Effectiveness was defined as ≥50% seizure reduction. Safety was measured by the numbers of emergency visits and complications. Economic impact was analyzed by calculating total costs of treatment. Statistical analyses: Non-inferiority of outpatient initiation was tested using 95% confidence intervals of the differences in effectiveness and safety endpoints between groups with non-inferiority margins of 10%. Nonparametric bootstrap techniques were used to derive a 95% confidence interval for the mean difference in total costs between the groups. Results: Hundred and five patients started KD in the period 2001 to 2017: 43 inpatient and 62 outpatient. At three months, the KD was effective in 61% of outpatients versus 63% of inpatients. The KD was considered safe in 36% of the outpatients, as compared to 29% in the inpatients. Outpatient initiation was shown to be non-inferior to inpatient initiation in terms of safety. Total health care costs of outpatient initiation were € 2901, as compared to € 8195 of inpatient initiation per patient (mean difference € 5294, 95% CI; -€ 7653 to -€ 2935). Conclusions: Our study suggests that outpatient KD initiation is no worse than inpatient initiation in terms of effectiveness and safety, while carrying lower health care costs.

Additional Metadata
Keywords Costs, Ketogenic diet, Refractory epilepsy, Seizure reduction, Side effects
Persistent URL dx.doi.org/10.1016/j.ejpn.2019.06.001, hdl.handle.net/1765/117916
Journal European Journal of Paediatric Neurology
Citation
van der Louw, E.J.T.M, Olieman, J.F, Poley, M.J, Wesstein, T. (Tessa), Vehmeijer, F.O.L, Catsman-Berrevoets, C.E, & Neuteboom, R.F. (2019). Outpatient initiation of the ketogenic diet in children with pharmacoresistant epilepsy: An effectiveness, safety and economic perspective. European Journal of Paediatric Neurology. doi:10.1016/j.ejpn.2019.06.001