Background
Methods
Results
Study | Study design | N | Country Patient population | Study objective | Follow-up period | Economic outcomes measured |
---|---|---|---|---|---|---|
Beghi et al. 2004 [14] | Cohort study | 631 | Italy 18 years of age and older NDE, SR, OS, NDR, DR or SC* (HIC) | To investigate the costs of epilepsy in different prognostic categories | 12 months | - Direct costs |
Boon et al. 2002 [15] | Cohort study | 84 | Belgium All ages Pre-surgical candidates who underwent a complete pre-surgical evaluation at Ghent University Hospital (HIC) | To compare and economically evaluate epilepsy-related direct medical costs incurred by different treatment modalities (conservatively, surgically and vague nerve stimulation- treated) and to determine. | Mean follow-up interval of 26 months | - Direct costs |
Cockerell 1994 [4] | Cohort study | 602 | UK Newly diagnosed seizure disorder (sample of the National General Practice Study of Epilepsy (NGPSE) (HIC) | To assess the epilepsy related socio-economic costs in a population so that health care priorities can be set | Mean follow-up interval 6.6 years | - Direct costs |
Das et al. 2007 [25] | Cohort study | 1450 | India No age indicated New patients with epilepsy in the Burdwan district (LMIC) | To evaluate the rate of discontinuation of epilepsy treatment and the related socio-economic factors responsible for discontinuation | 12 months | - Direct costs - Indirect costs - Income |
De Zelicourt et al. 2000 [20] | Cohort study | 1942 | France More than 1 month of age, Newly diagnosed unprovoked seizure (HIC) | Estimation of the direct medical cost for patients during the first two years after diagnosis | 24 months | - Direct costs |
Farmer et al. 1992 [26] | Quasi randomized trial | 215 | Ecuador No age indicated Epilepsy (identified in an epidemiological survey) (UMI) | To report the effects of epilepsy and its treatment on the social functioning of patients treated in Northern Ecuador | 12 months | - Employment status |
Guerrini et al. 2001 [16] | Cohort study | 189 | Italy Children and adolescents Followed up by child neurologist (university department, general hospital, outpatient department) (HIC) | To compare the direct costs of epilepsy in a child neurology referral population, stratified by disease, duration, and severity, across three health care settings. | 12 months | - Direct costs of epilepsy |
Halpern et al. 2011 [34] | Cohort study | 574 | USA All ages Epilepsy (HIC) | To assess whether people with epilepsy who are uninsured and those who have Medicaid coverage have greater out-of-pocket costs | 6 years | - Out-of-pocket costs |
Helmstaedter et al. 2000 [33] | Cohort study | 161 | Germany Adults Surgically or non-surgically treated patients with drug-resistant temporal lobe epilepsy (HIC) | To investigate the long-term effects of surgical and non-surgical treatment of drug-resistant temporal lobe epilepsy according to socioeconomic development | Mean follow-up interval 58 months | - Employment status |
Kotsopoulos et al. 2003 [17] | Cohort study | 116 | Netherlands Age not indicated Established epilepsy, recruited from three patient populations (general practices, university hospital and epilepsy centre) (HIC) | (a) To gain insight into the direct and indirect costs of epilepsy care, and (b) To analyse the distribution of these costs by type of services for each patient group | 3 months (and 3 months retrospective) | - Direct costs - Indirect costs - Out-of-pocket costs |
Langfitt et al. 2007 [18] | Cohort study | 68 | USA. Age not indicated Temporal lobe epilepsy patients (HIC) | To determine whether health care costs change when seizures are controlled after surgery | 2 years (and 2 years pre-evaluation) | - Direct costs |
Lindsten et al. 2002 [21] | Case–control study | 63 | Sweden 17 years of age or older Newly diagnosed unprovoked seizure in Vaesterbotten, northern Sweden (HIC) | To investigate the socioeconomic prognosis after a newly diagnosed unprovoked epileptic seizure | 10 years | - Income - Source of income - Sickness periods - Incapacity rate - Vocational status - Education |
Pato Pato et al. 2011[22] | Cohort study | 171 | Spain Over 14 years of age Epilepsy (HIC) | To carry out an economic estimate of the direct, indirect and intangible costs of epilepsy | 6 months | - Direct costs - Indirect costs - Intangible costs |
Tetto et al. 2002 [19] | Cohort study | 525 | Italy All ages NDE, SR, OS, NDR, DR and SC from 14 epilepsy centres (HIC) | To compare the direct costs of epilepsy in patients referred with epilepsy of different severity and duration | 12 months | - Direct costs |
Balabanov et al. 2007 [24] | Cohort study | 146 | Bulgaria 18 years of age and older recruited from an epilepsy centre Epilepsy (UMIC) | To evaluate the effect of demographic and clinical factors on the quality of life and cost of treatment of epilepsy patients on monotherapy with carbamazepine and valproate | 12 months | - Direct costs - Indirect costs |
Lagunju et al. 2011 [32] | Cohort study | 215 | Nigeria Children over 18 months recruited from a paediatric neurology clinic Epilepsy (LMIC) | To estimate the total cost of childhood epilepsy and to provide essential information on the economic burden of childhood epilepsy in Nigeria | 12 months | - Direct costs - Out-of-pocket costs - Indirect costs |
Doumbia-Outtara et al. 2010 [31] | Cohort study | 70 | Cote d’Ivoire Adults recruited from an inpatient unit within a hospital department of neurology (LMIC) | To evaluate the efficacy and tolerance of anti-epileptic drugs and the financial cost of care | n/a | - Direct costs - Out-of-pocket costs - Indirect costs |
Dongmo et al. 2003 [30] | Cohort study | 125 | Cameroon All ages recruited from a medical centre Epilepsy (LMIC) | To evaluate the difficulties faced in the management of epileptic patients in their natural environment | 12 months | - Direct costs - Out-of-pocket costs |
Haroon et al. 2012 [29] | Cohort study | 134 | India All ages recruited from a centre of neuroscience within a national hospital Epilepsy (LMIC) | To evaluate the costs of active epilepsy and study the pattern of drug prescription and utilisation in epileptic patients | 4 months | - Direct costs - Out-of-pocket costs |
Strzelcyck et al. 2013 [23] | Cohort study | 252 | Germany All ages recruited from an outpatient clinic within a university hospital Focal epilepsy (HIC) | To estimate the direct and indirect costs of epilepsy and evaluate trends in the resource use of patients with active epilepsy. | 12 months | -Direct costs -Indirect costs |
Lv et al. 2007 [28] | Cohort study | 533 | China Parents of children with epilepsy recruited from the outpatient clinic of a tertiary hospital epilepsy centre Epilepsy (UMIC) | To assess the impact of childhood epilepsy on parental quality of life (QoL) and psychological health, and to investigate possible correlations between parental QoL, background variables and parental anxiety and depression | 12 months | - Direct costs - Income - Employment status |
Vlasov et al. 2010 [27] | Cohort study | Russia Epilepsy (HIC) | To evaluate the clinical-economic effectiveness of anti-epileptic drug (AED) therapy | 12 months | -Direct costs |
Study | Total direct costs | Out-of-pocket costs | Direct cost summary |
---|---|---|---|
Beghi et al. 2004 [14] | Mean costs: €1302 Subgroups: NDE: €975; SR: €561 OS: €830; NDR: €1498; DR: €2568 SC: €3619 | n/a | Costs of epilepsy patients vary significantly according to time course of the disease and response to treatment. Hospital admissions and drugs are major sources of expenditure |
Boon et al. 2002 [15] | Conservatively treated Before: $ 2,525 After: $ 2,421 Surgically treated Before: $ 1,465 After: $ 1,186 Vagus Nerve Stimulation-treated Before: $ 4,826 After: $ 2,496 | n/a | As a result of offering epilepsy surgery and VNS to the patients, the costs of the most expensive patient group are reduced to the mean cost level of patients with refractory epilepsy. It takes some years to balance all direct costs incurred by epilepsy surgery and VNS by the savings after better seizure control and fewer hospital admissions. |
Cockerell et al. 1994 [4] | Newly diagnosed seizures: £611 (first year); £169 per patient per annum (subsequent years) | n/a | Direct cost of £611 per patient per annum which decreased after eight years of follow-up to £169 per patient per annum. |
De Zelicourt et al. 2000 [20] | First year: FF 14 305 Second year: FF 3 766 | n/a | Cost during first year sensitive to aetiologic categorisation of seizures and other clinical parameters. Cost during second year sensitive to frequency of seizure and treatment with AEDs. |
Guerrini et al. 2001 [16] | Mean annual cost: €1,767 Subgroups: Newly diagnosed epilepsy: €1,907 Seizure remission: €844 Frequent non-drug-resistant seizures: €1,112 Drug-resistant seizures: €3,268 | n/a | The cost of epilepsy tends to vary significantly depending on the severity and duration of the disease. Hospital services and drugs are the major sources of costs. The setting of health care plays a significant role in the variation of the costs, even for patients in the same category of epilepsy. |
Halpern et al. 2011 [34] | n/a |
1:Private; 2:Medicare age <65; 3:Medicare age ≥65; 4:Medicaid, 5:Uninsured
Outpatient visits 1) $266; 2) $56; 3) $414; 4) $10; 5) $397 Hospital stays 1) $344; 2) $5; 3) $258; 4) $2; 5) $1018 Emergency department 1) $124; 2) $16; 3) $38; 4) $33; 5) $860 Prescription medication 1) $809; 2) $2192; 3) $1446; 4) $524; 5) $1597 | Uninsured individuals had significantly fewer outpatient visits with neurologists, and greater antiepileptic drug costs than did those with private insurance. Individuals with Medicaid coverage had similar medical resource utilization but lower out-of-pocket costs compared with privately insured individuals. |
Kotsopoulos et al. 2003 [17] | GP: €625 UH: €3,393 EC: €4,292 | GP: €84 UH: €1,767 EC: €1,164 | Patients from GP appeared to have lower direct costs. The cost items anti-epileptic drugs, hospital services, unpaid care, and transportation accounted for the majority of the total direct costs. |
Langfitt et al. 2007 [17] | Baseline vs Follow up Persisting seizure group: $2,224 vs $2,982 No surgery group: $1,838 vs $2,567 Surgery, seizure free group: $2,294 vs $1,561 | n/a | Costs remain stable over 2 years post-evaluation in patients with temporal lobe epilepsy whose seizures persist, but patients who become seizure free after surgery use substantially less health care than before surgery. Further cost reductions in seizure-free patients can be expected as antiepileptic drugs are successfully eliminated. |
Pato Pato et al. 2011 [22] | €2,110 per year (€ 1055 for 6 months) | n/a | See table 3 |
Tetto et al. 2002 [19] | NDE: €1002; SR: €412; OS: €558; NDR: €1626; DR: €2198; SC: €3945 | n/a | The direct costs of epilepsy vary significantly depending on the severity of the disease and the response to treatment. Hospital admissions and drugs are the most common items of expenditure. |
Balabanov et al. 2007 [24] | Patients on Carbamazepine Up to 2 adverse events (AEs): €339 2 or more AEs: €806 Patients on Valproate monotherapy Up to 2 AEs: €581 2 or more AEs: €555 | n/a | Age, gender and type of seizure did not cause major differences in direct costs. In Carbamazepine patients costs were influenced by the incidence of AEs, time between seizures and percentage of seizure reduction. In Valproate patients costs were influenced by the time period between seizures. |
Lagunju et al. 2011 [32] | n/a | Median direct costs for one year AED costs: US$288 In-patient care: US$333 Investigation costs: US$80 Out-patient costs: US$32 Transportation: US$20 Home care: US$800 | Carers of children with epilepsy incur very high out-of-pocket expenses due to a lack of well-established national health insurance programme and social support services. |
Doumbia-Outtara et al. 2010 [31] | n/a | Mean direct costs of hospitalisation: 148 715 FCFA Examination: 74 FCFA Accommodation: 58 FCFA Anti-epileptic medicines: 17 FCFA | Phenobarbital was the most frequently used AED (40%) and is the treatment of choice for patients. Financial accessibility to modern treatment of epilepsy is difficult as the cost of care is very high compared to the average salary. 22% of patients left the unit prematurely due to lack of financial means. |
Dongmo et al. 2003 [30] | n/a | Average cost of treatment per patient: 31 CFA/day | Phenobarbital was the most frequently used AED (75%). Compliance rate was 71% and the main reason for non-compliance was a lack of finances. |
Haroon et al. 2012 [29] | n/a | Direct cost to epilepsy patients prescribed 1-4 AEDs 1 AED: Rs5943 2 AEDs: Rs8429 3 AEDs: Rs10091 4 AEDs: Rs10683 | The direct cost to patients increased linearly with the addition of AEDs to patients’ prescription. The majority of patients belonged to the lower middle income group. Some newer AEDs had a higher monthly cost (lamotrigine, levetiracetam and lacosamide) compared to older AEDs. Clobazam had the lowest cost of all newer AEDs. |
Strzelcyck et al. 2013 [23] | Direct costs per patient (2003 cohort) Anticonvulsant drugs: €600 Hospitalisation: €280 Rehabilitatoin: €90 Diagnostic work-up: €20 Outpatient care: €10 Physical treatment: €10 Special equipment: €3 Total: €1010 Direct costs per patient (2008 cohort) Anticonvulsant drugs: €729 Hospitalisation: €350 Rehabilitatoin: €112 Diagnostic work-up: €25 Outpatient care: €13 Physical treatment: €13 Special equipment: €4 Total: €1266 | n/a | Direct costs shifted during the 5-year period of evaluation of trends and resource. During this time hospital costs increased and a cost-neutral increase was observed in the prescription of ‘newer’ AEDs. |
Vlasov et al. 2010 [27] | Direct cost of seizures per patient (employed) Primary generalized: 80 124,61 RUB Secondary generalized: 84 006,43 RUB Partial focal: 77 099,28 RUB Complex focal: 7014,04 RUB Polymorphic/undifferentiated: 84 461,56 RUB Direct cost of seizures per patients (unemployed) Primary generalized: 67 754,36 RUB Secondary generalized: 76 528,79 RUB Partial focal: 61 384,87 RUB Complex focal: 66 386,91 RUB Polymorphic/undifferentiated: 85 380,58 RUB | n/a | Although direct costs of treatment increased during the study period, the cost-benefit ratio significantly decreased by 2-3 times in all types of seizures. The study found that rational treatment using ‘new’ AEDs would allow a reduction of the total cost of treatment. |
Study | Employment Status | Productivity loss | Income | Indirect costs summary |
---|---|---|---|---|
Das et al. 2007 [25] | Most reported reason for discontinuation was cost (90%). Discontinued group Average annual cost of treatment: Rs.5500 ($110) Income: Rs.12,800 ($256) Continued group Annual cost of treatment: Rs.4500 ($90) Income: Rs.24,400 ($580) | |||
Farmer et al. 1992 [26] | No difference in work days between people with epilepsy and controls. Not enough details provided in published paper to provide quantitative comparison | |||
Helmstaeder et al. 2000 [33] | (Baseline/Followup) N=161: School (30/12) Employed (82/87) Unemployed (11/18) Incapacitated (21/29) House wife/husband (17/15) | Socioeconomic outcomes was poorer in nonsurgical than in surgical patients | ||
Kotsopoulos et al 2003 [17] | Temporally sick (n) GP: 1; UH: 7; EC: 4 Permanently sick GP: 0; UH: 0; EC: 3 Work on therapeutic basis GP: 0; UH: 0; EC: 2 Unemployed GP: 0; UH: 0; EC: 2 Retired GP: 3; UH: 11; EC: 2 Early retirement GP: 0; UH: 2; EC: 1 Part-time employment GP: 1; UH: 1; EC: 0 | Production days lost (days/month) GP: 0 UH: 0 EC: 0.26 Productivity loss (hours/month) GP: 0 UH: 0.30 EC: 0.92 | People with epilepsy from the EC reported the highest productivity losses and unemployment rates | |
Lindsten et al. 2002 [21] | (Control/Patients) 1986-1990 (79/47) Employed (76/41) Unemployed (3/3) Student (0/3) 1991-1993 (73/42) Employed (67/38) Unemployed (4/1) Student (2/3) 1994-1996 (68/40) Employed (60/34) Unemployed (5/3) Student (3/3) 1997 (65/39) Employed (63/33) Unemployed (5/3) Student (0/4) | (Control/Patients) 1986-1990 (82/50) From employment (75/33) Sickness allowance (0/5) Study grant/unemployment benefit (3/6) Disability pension (4/4) Other sources (-/2) 1991-1993 From employment (69/33) Sickness allowance (0/4) Study grant/unemployment benefit (4/3) Disability pension (3/5) Other sources (-/2) 1994-1996 From employment (57/28) Sickness allowance (2/4) Study grant/unemployment benefit (7/5) Disability pension (4/6) Other sources (-/1) 1997 From employment (58/27) Sickness allowance (2/2) Study grant/unemployment benefit (6/7) Disability pension (2/6) Other sources (-/1) | After a newly diagnosed unprovoked epileptic seizure, no negative outcomes regarding employment and education. Income increases unless there is an onset of refractory seizures. Income is lower among patients with epilepsy than controls. This difference can be related to overall morbidity. | |
Pato Pato et al 2011 [22] | €3,058 per year (€1,529 for 6 months) | Indirect costs due to work productivity losses are substantial and substantially more than direct costs | ||
Balabanov et al. 2007 [24] | Days off work, sick leave days and reduction of salary due to incapacitation were calculated for each patient. These costs were not reported. | Not reported | ||
Strzelczyk et al. 2013 [23] | (2003 cohort) Early retirement: €780 Productivity loss due to part-time work/unemployment: €420 Off-days due to seizures: €410 Total indirect costs: €1610 (2008 cohort) Early retirement: €818 Productivity loss due to part-time work/unemployment: €441 Off-days due to seizures: €430 Total indirect costs: €1689 | The amount and distribution of indirect cost components did not change significantly between cohorts. | ||
Lagunju et al. 2011 [32] | Median cost of mother out of work for one year: US$ 1280 | Thirty-seven (17.2%) of mothers gave up their jobs to take care of their child with epilepsy. The annual income lost by families due to this ranged from US$480 to US$1280. The overall mean cost of loss of employment across all 215 child participants was US$493. | ||
Lv et al. 2009 [28] | Parents of children with epilepsy: Full-time work: (203/263) Part-time work: (38/263) Don’t work for epilepsy: (22/263) Parents of children without epilepsy: Full-time work: (270/270) | Parents of children with epilepsy: Median household income, Yuan/month: 2800 Mean cost of epilepsy, Yuan/month:4164 Parents of children without epilepsy: Median household income, Yuan/month:3000 | Indirect costs of childhood epilepsy have a severe impact on parental quality of life (QoL) and psychological health. Unemployment in particular, can lead to extreme economic hardship. |
Direct costs – health system
Determinants of costs and variation in direct costs
Direct costs – out-of-pocket costs
Indirect costs – productivity loss
Indirect costs – employment status
Determinants of costs and variation in indirect costs
Outcome measurement
Quality of studies
1 | 2 | 3 | 4 | 5 | 6 | |
---|---|---|---|---|---|---|
Beghi et al. 2004 [14] | Y | Y | Y | Y | ? | Y |
De Zelicourt et al. 2000 [20] | Y | Y | Y | Y | ? | Y |
Helmstaedter et al. 2000 [33] | Y | Y | N | ? | ? | Y |
Lindsten et al. 2002 [21] | Y | Y | N | Y | N | ? |
Pato Pato et al. 2010 [22] | Y | N | Y | ? | Y | Y |
Das et al. 2007 [25] | Y | Y | N | Y | ? | Y |
Tetto et al. 2002 [19] | Y | N | Y | ? | ? | Y |
Kotsopolous et al. 2003 [17] | Y | ? | N | ? | ? | Y |
Langfitt et al. 2007 [18] | Y | Y | Y | Y | Y | Y |
Halpern et al. 2011 [34] | ? | Y | N | N | N | Y |
Farmer et al. 1992 [26] | Y | ? | N | Y | N | ? |
Boon et al 2002 [15] | Y | Y | Y | ? | Y | ? |
Guerrini et al. 2001 [16] | Y | Y | ? | ? | ? | ? |
Cockerell et al 1994 [4] | Y | ? | ? | N | ? | ? |
Balabanov et al 2008 [24] | Y | Y | N | ? | Y | N |
Lagunju et al 2011 [32] | Y | Y | Y | N/A | Y | Y |
Strzelczyk et al 2013 [23] | Y | Y | Y | ? | Y | Y |
Lv et al 2009 [28] | Y | Y | ? | ? | ? | ? |
Doumbia-Outtara et al. 2010 [31] | Y | N/A | Y | ? | Y | N/A |
Dongmo et al. 2003 [30] | Y | N/A | Y | ? | Y | N/A |
Haroon et al. 2012 [29] | Y | Y | Y | ? | Y | Y |
Vlasov et al 2010 [27] | Y | N | ? | N | Y | Y |