Elsevier

Epilepsy & Behavior

Volume 27, Issue 3, June 2013, Pages 433-438
Epilepsy & Behavior

Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany

https://doi.org/10.1016/j.yebeh.2013.03.007Get rights and content

Highlights

  • Epilepsy causes considerable use of health-care resources and loss of productivity.

  • We evaluated the trends in the use of health-care resources over a 5-year period.

  • We demonstrated increased hospital costs and a cost-neutral increase of ‘newer’ AEDs.

  • The proportion of enzyme-inducing and ‘old’ AEDs decreased between 2003 and 2008.

  • Early retirement was the main cost factor despite improved labor market opportunities.

Abstract

This study evaluated trends in the resource use of patients with active epilepsy over a 5-year period at an outpatient clinic of a German epilepsy center. Two cross-sectional cohorts of consecutive adults with active epilepsy were evaluated over a 3-month period in 2003 and 2008. Data on socioeconomic status, course of epilepsy, as well as direct and indirect costs were recorded using validated patient questionnaires.

We enrolled 101 patients in 2003 and 151 patients in 2008. In both cohorts, 76% of the patients suffered from focal epilepsy, and the majority was on antiepileptic drug (AED) polytherapy (mean AED number: 1.7 (2003), 1.8 (2008)). We calculated epilepsy-specific costs of €2955 in 2003 and €3532 in 2008 per 3 months per patient. Direct medical costs were mainly due to anticonvulsants in 2003 (59.4% of total direct costs, 34.0% in 2008) and to hospitalization in 2008 (46.9% of total direct costs, 27.7% in 2003). The proportion of enzyme-inducing anticonvulsants and ‘old’ AEDs decreased between 2003 and 2008. Indirect costs of €1689 and €1847 were mainly due to early retirement (48.4%; 46.0% of total indirect costs in 2003; 2008), unemployment (26.1%; 24.2%), and days off due to seizures (25.5%; 29.8%).

This study showed a shift in distribution of direct cost components with increased hospital costs as well as a cost-neutral increase in the prescription of ‘newer’ AEDs. The amount and distribution of indirect cost components remained unchanged.

Introduction

Epilepsy is a common and chronic neurological disorder that imposes a substantial burden on individuals and society as a whole. The majority of patients require an anticonvulsant treatment for an extended period of time, and seizures in up to 30% of patients are refractory to medical treatment [1]. Economic evaluations are particularly important in patients with active epilepsy as they account for a high proportion of total costs [2], [3], [4], [5]. Given the growing resource utilization and limited amount of health-care resources, it has become essential to gather reliable cost estimates as a scientific basis for resource allocation and health policy decision making. In fact, this has become even more important as the introduction of new antiepileptic drugs, the use of generic medication, the marketing of brain stimulation devices, and the resurgence of new surgical treatment options can result in a considerable increase in costs or a shift in the distribution of cost components [6], [7], [8], [9], [10]. Furthermore, epilepsy is still strongly associated with social stigma, reduced employment opportunities, and impaired quality of life for patients and their caregivers, resulting in increased indirect costs [11], [12], [13], [14], [15].

Comparisons between cost-of-illness (COI) studies are difficult because of the differences in methods of cost evaluation and the recruited populations [7], [16]. To date, no studies have evaluated trends in resource utilization over a long period of time. In 2003, we performed a COI study [3] in patients with active epilepsy attending the outpatient clinic of a tertiary epilepsy center. This was the first German study to provide a comprehensive set of data on direct and indirect costs. Previous German COI studies focused on certain aspects such as seizure frequency [17] or medication costs [18]. We demonstrated that indirect costs outweighed direct costs, while early retirement was the main cost factor for indirect costs and anticonvulsant medication for direct costs [3].

Thus, the objective of this study was to determine the trends in the utilization of health-care resources in active epilepsy over a 5-year period. We used the same inclusion criteria and methods of cost evaluation for a second cohort of patients with active epilepsy evaluated in 2008.

Section snippets

Study setting and design

The study was performed at the epilepsy outpatient clinic of the University Hospital of Marburg. The University Hospital of Marburg is a large multispecialty tertiary care hospital in the state of Hesse that provides health care to a population of over 1,000,000 patients. Marburg lies within the postal code area 35 used previously for a population-based estimation of the incidence of status epilepticus [19].

The study population consisted of two cohorts of outpatients with an established

Patient groups

We enrolled 101 patients with active epilepsy in 2003 and 151 patients in 2008. There were no differences in age or sex distribution or disease duration between the two groups. An equal percentage (76%) suffered from focal epilepsy, and the majority of the patients were on antiepileptic drug (AED) polytherapy. Table 1 shows the sociodemographic and clinical characteristics of both cohorts. We surveyed the 2008 cohort in more detail in terms of marital status, education, job qualification,

Discussion

Patients with active epilepsy account for a high proportion of total costs due to epilepsy. This study is the first evaluation to address changes over a 5-year period in resource utilization and prescription of anticonvulsants by applying the same inclusion criteria and methods of cost evaluation. By comparing patients with active epilepsy during two 3-month evaluation periods separated by 5 years, we were able to demonstrate a shift in the distribution of direct cost components as well as an

Conflict of interest

Dr. A. Strzelczyk has received travel support and honoraria from Desitin, Eisai, and UCB Pharma. Dr. W.H. Oertel has received honoraria and/or research grants from Boehringer Ingelheim, Desitin, GlaxoSmithKline, Merck, Mundipharma, Novartis, Orion, Sharp & Dohme, Schwarz Pharma Neuroscience/UCB Pharma, Synosia, and Teva. Dr. Knake has served on the speakers' bureau of Desitin and Eisai. Dr. Rosenow has received honoraria as a scientific advisor from GlaxoSmithKline, Eisai, UCB Pharma, and

Acknowledgments

We are grateful to all of our colleagues for their assistance in conducting this study. This study was supported by an unrestricted grant from “Verein zur Erforschung der Epidemiologie der Epilepsien e.V.”, Desitin, GlaxoSmithKline, Janssen-Cilag, and UCB Pharma. The funding sources had no role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript.

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