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Table 2 Summary of findings – direct costs

From: The economic impact of epilepsy: a systematic review


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


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


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)


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


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


Newly diagnosed epilepsy: €1,907

Seizure remission: €844

Frequent non-drug-resistant seizures: €1,112

Drug-resistant seizures: €3,268


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]


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


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)


See table 3

Tetto et al. 2002 [19]

NDE: €1002; SR: €412; OS: €558; NDR: €1626; DR: €2198; SC: €3945


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


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]


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]


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]


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]


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


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


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


85 380,58 RUB


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.

  1. Abbreviations: AED antiepileptic drugs, DR drug-resistant seizures, EC epilepsy centre, GP general practices, NDE newly diagnosed epilepsy, NDR frequent non-drug-resistant seizures, OS occasional seizures, SR seizure remission, SC surgical, UH university hospital, na not colleted or not reported.