Laser Interstitial Thermal Therapy
Health Technology Assessment Committee Recommendations
- Laser Interstitial Thermal Therapy not be publicly provided for patients with intracranial lesions or epilepsy in British Columbia until more evidence of its clinical and cost effectiveness is available.
- Given the potential of the procedure to someday provide a non-invasive alternative to surgery, the committee supports the continued use of LITT in research (clinical trial settings).
Health Technology Assessment Committee Findings
The business case submitted to the Health Technology Assessment Committee (HTAC) reviewed the effectiveness of LITT for the treatment of epilepsy or intracranial lesions in BC. Recommendations were based on the following committee findings:
- The effectiveness of LITT is uncertain. Published literature is very limited and studies have small sample sizes and weak study designs.
- There were no studies identified comparing LITT to the standard of care for intracranial lesions.
- Two (non-randomized) studies on epilepsy were identified. One found improvements in face recognition and common names, while the other found that seizure frequency did not significantly differ compared to surgical resection.
- There were no relevant economic evaluations or clinical guidelines regarding LITT.
- The NeuroBlate system is the only LITT device approved for use by Health Canada.
- Use of LITT in Canada is currently limited to BC, where it has been used at the Vancouver General Hospital since December 2014. The Hospital for Sick Children in Toronto is considering purchasing a Neuroblate system, and is hoping to be able to provide LITT as an option for children with epilepsy by the spring of 2016.
- The cost of the system is $540,390 plus annual warranty costs of $73,878 (paid for via a private donation at VGH).
- The cost per procedure is estimated to be $23,623 by the University of Calgary (assuming two mini-bolts and probes per procedure). The clinical expert consulted suggested that typical cases require only one of each, which drops the cost per procedure to $13,663. The cost of undertaking 24 procedures (current utilization) per year at VGH (excludes cost to purchase the system) would be $640,830.
- No studies were found evaluating the patient experience or quality of life of LITT patients with epilepsy or brain metastases. However, the patient experience with LITT is described as positive by clinicians, and also by the patient interviewed.
- Some clinicians interviewed see LITT (along with robotics) as the future of neurosurgery due to its minimally invasive nature. The Committee agreed that the technology is innovative and has potential to transform care for patients in the future.
- A press release from the Neuroblate manufacturer states that as of February 2015, more than 300 procedures have been performed at 22 USA institutions.