Work

Promotion and economic considerations of domestic Vagus nerve stimulation within the Chinese three-tier epilepsy center system

Year: 2026

Type: article

Abstract: Background Epilepsy affects approximately 10 million people in China, with about 30% developing drug-resistant epilepsy (DRE). Vagus Nerve Stimulation (VNS) is an established neuromodulation therapy for DRE. Domestic VNS devices completed clinical trials in 2014 and entered clinical use in 2016. This study synthesizes clinical outcomes, promotion pathways, and economic considerations of domestic VNS devices within the Chinese three-tier epilepsy center network established by the China Association Against Epilepsy (CAAE). Methods This narrative synthesis integrates data from previously published multicenter prospective real-world studies, CAAE accreditation records, market research, and health economics literature. Clinical outcome data were derived from studies encompassing 124 adult and 87 pediatric patients with DRE across 86 epilepsy centers. A cost comparison between domestic and imported VNS devices was performed based on market data and implantation volumes from 2022–2025. Results In adults, responder rates (≥50% seizure reduction) increased progressively from 35.4% at 1 month to 76.6% at 12 months post-implantation, with seizure-free rates reaching 10.9%. In pediatric patients, according to the available follow-up data, ≥50% responder rates (combining seizure freedom, 75% reduction, and 50% reduction) were 43.4% at visit 2, 40.6% at visit 3, 56.6% at visit 4, and 55.8% at visit 5; seizure freedom rates ranged from 1.1 to 9.3% across visits. Significant improvements were observed in sleep quality (PSQI: 5.43 → 4.44), depression (NDDI-E: 6.49 → 4.83), anxiety (GAD-7: 7.15 → 4.95), and quality of life (QOLIE-31: 54.40 → 61.33). Adverse events were mild and transient, primarily voice changes (20.3%) and cough (8.6%). The three-tier network comprises 526 centers (45 Tier-3, 259 Tier-2, 222 Tier-1) with standardized protocols and telemedicine platforms. Conclusion Domestic VNS demonstrates encouraging efficacy, favorable safety, and improvements in comorbidities in both adult and pediatric DRE populations within the CAAE three-tier network. The network provides a structured framework for standardized application. However, the evidence is limited by the uncontrolled design of the primary studies, short follow-up, and the absence of a formal cost-effectiveness analysis. Prospective comparative clinical and economic validation is warranted.

Source: Frontiers in Neurology

DOI: 10.3389/fneur.2026.1963297