The costs of epilepsy in three different populations of patients with epilepsy
Introduction
As a chronic health condition, epilepsy has, along with the medical costs, a wide range of added healthcare costs, such as the costs of unemployment and the costs of caregivers.
Because of the time and resources involved in obtaining direct actual data, estimates of the costs of epilepsy are often based on retrospective data or models of epilepsy management (Begley et al., 1999). There are various sources from which direct data can be obtained, such as patient records, insurance company data bases, questionnaires, and cost diaries. Cost diaries can provide detailed resource use information prospectively. Thus, they generally provide detailed and reliable reporting of data over a period of time. Although cost diaries have been used for estimating the direct and indirect costs of chronic diseases, such as fibromyalgia and chronic back pain (Goossens et al., 2000), until now no cost diary has been developed to estimate total resource use for patients with epilepsy. In contrast, cost questionnaires have been applied earlier as a method for measuring the direct and indirect costs of epilepsy retrospectively (Jacoby et al., 1998).
So far, only one study has compared the costs of epilepsy from three different healthcare settings (Guerrini et al., 2001).
With these considerations in mind, we conducted a study of the costs of epilepsy care in three different populations of patients with epilepsy in The Netherlands. The objectives of this study were: (a) to gain insight into the direct and indirect costs of epilepsy care, (b) to analyse the distribution of these costs by type of services for each patient group, and (c) to compare the costs estimated prospectively by means of a cost diary and retrospectively by means of a cost questionnaire. In addition, for each group of patients the seizure frequency and the patients’ perception of their quality of life have been explored.
Section snippets
Selection of patients
Patients with established epilepsy were recruited from three different patient populations. The first subgroup of patients was selected from 14 general practices (GP) throughout the province of Limburg, which is located in the south of The Netherlands. They were included in the study if (a) only general practitioners were responsible for their actual care and (b) at least 3 months before their enrollment in the study, they had been discharged from further follow-up visits at the outpatient
Study population
In total, 116 patients with established epilepsy (24 patients from GP, 49 from the outpatient Department of Neurology of the UH, and 43 patients from the outpatient department of the EC) returned at least one cost diary or cost questionnaire. In total, 67% of the returned diaries and cost questionnaires were completed for all variables, whereas the rest were partly completed for some of the variables. Specifically, 71% of the patients from the GP, 81% of the patients from the UH, and 51% of the
Discussion
In this study, we estimated the costs of care in three different populations of patients with epilepsy by obtaining direct actual data on epilepsy-attributable services from cost diaries and questionnaires. The mean direct costs per month varied between 52.08 and 357.63€.
In total, two-thirds of the returned cost diaries and questionnaires were completed, which corresponds with the response rate reported by Goossens et al. (2000). In estimating direct costs, we attempted to be complete by
Acknowledgements
The authors thank the RNH (Registration Network of General Practices) who assisted in the inclusion of patients from general practices throughout the province of Limburg.
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