Costs of epilepsy and their predictors: Cross-sectional study in Germany and review of literature

Abstract

IntroductionEpilepsy as a chronic neurological disease imposes a substantial burden on individuals and society through the considerable use of health-care resources and the loss of productivity. The aim of this cross-sectional study was to quantify epilepsy-related costs in Germany and to identify cost-driving factors. In addition, we reviewed recent studies on costs of epilepsy and put the present results in an international perspective. Patients and methodsAdult patients with epilepsy from 32 general practitioners, 6 neurologists and an epilepsy center were enrolled for a three months observation period in 2008. Data on socioeconomic status, course of epilepsy as well as direct and indirect costs were recorded using validated patient questionnaires and evaluated from the societal perspective. ResultsWe enrolled 494 patients (232 male, 46.9%) with a mean age of 46.3±17.1 years (range 18–89 years). We calculated epilepsy-specific direct costs of €599 per patient per three months in the primary care sector and €1354 at the epilepsy outpatient clinic. Direct medical costs were mainly due to hospitalization (29.7% in primary care sector and 40.7% at epilepsy outpatient clinic of total direct costs) and anticonvulsants (29.0% and 36.8%). Indirect costs were estimated at €1486 per patient per three months in the primary care sector and €1971 at the epilepsy outpatient clinic. Indirect costs were mainly due to early retirement (39.0% and 49.6% of total indirect costs), unemployment (29.3% and 28.3%) and days off due to seizures (31.7% and 21.2%). Direct costs for AEDs and hospital treatment but not indirect costs were significantly higher in patients treated at the epilepsy center as compared to the primary care sector. Predictors of higher medication and total direct costs were active epilepsy, focal epilepsy syndromes, worse prognostic groups and higher seizure frequency. ConclusionIndirect costs remained higher than direct costs in this study conducted in primary care sector and at an epilepsy center in Germany. Our study and other recent studies with a top-down approach demonstrated hospitalization beside AED costs as an important direct cost factor.