Subject: Washington State Health Care Authority Proposal 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 wish to express our support for
the inclusion of vagus nerve stimulation (VNS) for epilepsy and treatment-resistant depression (TRD) on
the list of procedures for re-review by the Washington State Health Care Authority (HCA) Health
Technology Assessment (HTA) program in 2019. We agree with the HCA that new evidence has
become available since the HTA program decision in 2009 not to cover VNS for depression.
Despite decades of research, patients with treatment-resistant depression (TRD) continue to have very
limited options. We are pleased to see that the Washington State HTA program has recognized that
additional evidence exists for VNS for TRD and we hope the review will result in a policy that will permit
more patients in the state of Washington to have access to this important 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 strong 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 lifesaving procedure available to appropriately selected patients without undue burden on the patient or the
treating surgeon.
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