Josiah Morse, MPH, Program Director
Washington State Health Care Authority
Health Technology Assessment Program
P.O. Box 42712
Olympia, WA 98504-2712
Via e-mail: shtap@hca.wa.gov
Subject: Washington State Health Care Authority Evidence Report for Re-review of
Vagus Nerve Stimulation (VNS) for Epilepsy and Depression
Dear Mr. Morse:
On behalf of the American Association of Neurological Surgeons (AANS), the Congress of Neurological
Surgeons (CNS), the American Society for Stereotactic and Functional Neurosurgery (ASSFN) and the
Washington State Association of Neurological Surgeons (WSANS), we appreciate the opportunity to
review the draft evidence report prepared by the Center for Evidence-based Policy of the Oregon Health
& Science University for the review of vagus nerve stimulation (VNS) for epilepsy and treatment-resistant
depression (TRD). As we have previously noted, we support the re-review of this topic by the
Washington State Health Care Authority (HCA) Health Technology Assessment (HTA) program. We
believe that new evidence, which has become available since the HTA program’s non-coverage decision
in 2009, warrants a change to positive coverage.
Despite decades of research, patients with treatment-resistant depression (TRD) continue to have very
limited options. We were pleased to see that the Washington State HTA program has recognized that
additional evidence exists for VNS for TRD, and we hope the HCA HTA Health Technology Clinical
Committee will recommend positive coverage to allow patients in the state of Washington to have access
to this critical treatment option for their TRD. We believe the current literature is robust and shows clear
evidence of efficacy and cost-benefit for VNS for TRD. As part of the Food and Drug Administration
(FDA) approval process in 2005, and since that time, a substantial body of evidence has been developed
for VNS for TRD. With suicide continuing to be among the top ten causes of death in the United States,
we urge the HCA to make this potentially life-saving procedure available to appropriately selected
patients without undue burden on the patient or the treating surgeon.
Read full letter here
