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Table 2 Summary of findings – direct costs

From: The economic impact of epilepsy: a systematic review

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.
  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.