Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany
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.
References (61)
- et al.
The costs of epilepsy in Italy: a prospective cost-of-illness study in referral patients with disease of different severity
Epilepsy Res
(2002) - et al.
Cost of disorders of the brain in Europe 2010
Eur Neuropsychopharmacol
(2011) - et al.
Clinical and economic impact of vagus nerve stimulation therapy in patients with drug-resistant epilepsy
Epilepsy Behav
(2011) - et al.
Epilepsy and employment: literature review
Epilepsy Behav
(2007) - et al.
Quality of life and employment status are correlated with antiepileptic monotherapy versus polytherapy and not with use of “newer” versus “classic” drugs: results of the “Compliant 2006” survey in 907 patients
Epilepsy Behav
(2010) Stigma, epilepsy, and quality of life
Epilepsy Behav
(2002)- et al.
Socioeconomic status and self-management in epilepsy: comparison of diverse clinical populations in Houston, Texas
Epilepsy Behav
(2010) - et al.
Quality of life in 1931 adult patients with epilepsy: seizures do not tell the whole story
Epilepsy Behav
(2011) - et al.
Evaluation of health-care utilization among adult patients with epilepsy in Germany
Epilepsy Behav
(2012) - et al.
Direct medical costs for partial refractory epilepsy in Mexico
Arch Med Res
(2006)