Summary:Purpose: To provide 1995 estimates of the lifetime and annual cost of epilepsy in the United States using data from patients with epilepsy, and adjusting for the effects of comorbidities and socioeconomic conditions.Methods: Direct treatment-related costs of epilepsy from onset through 6 years were derived from billing and medical chart data for 608 population-based incident cases at two sites in different regions of the country. Indirect productivity-related costs were derived from a survey of 1,168 adult patients visiting regional treatment centers. Direct costs separate the effects of epilepsy and comorbidity conditions. Indirect costs account for the effects of other disabilities and socioeconomic conditions on foregone earnings and household activity. The estimates were applied to 1995 population figures to derive national projections of the lifetime and annual costs of the disorder.Results; The lifetime cost of epilepsy for an estimated 181,000 people with onset in 1995 is projected at $I I . 1 billion, and the annual cost for the estimated 2.3 million prevalent cases is estimated at $12.5 billion. Indirect costs account for 85% of the total and, with direct costs, are concentrated in people with intractable epilepsy.Conclusions: Direct costs attributable to epilepsy are below previous estimates. Indirect costs adjusted for the socioeconomic conditions of patients are above previous estimates. Findings indicate that epilepsy is unique in the large proportion of costs that are productivity-related, justifying further investment in the development of effective interventions. Key Words: Cost-Lifetime-UnitedStates-Direct-Indirect.Epilepsy is a neurologic condition characterized by recurrent unprovoked seizures. It affects -2.5 million people with 150-to 200,000 new cases a year in the United States (1). Most people with onset of seizures can achieve seizure control with existing medications. However, 20-25% have seizures that do not respond to treatment. Epilepsy is an economic burden on individuals and society because of increased health care cost as well as losses in employment, wages, and household work. Few studies have assessed the magnitude of the cost, because of difficulties in defining epilepsy, the limitations of national surveys, the problem of separating the cost of epilepsy from that of coexisting conditions, and the variability of the illness. The last comprehensive study was done in 1975. Accurate and up-to- E-mail: cbegley@utsph.uth.tmc. edu needed to provide insight into the potential opportunities for cost savings and for determining how to treat the disease cost-effectively.The goal of this study was to provide current estimates of both the lijetime and annual cost of epilepsy, addressing some of the methodologic problems of estimation. Lifetime costs include costs incurred from onset until remission or death. Such estimates are needed to value the economic gains of interventions that may prevent new cases or ameliorate the effects of the disorder on existing cases. Annual costs...

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A model of the clinical course of epilepsy from onset until remission or death has been developed for six prognostic groups, including survival, use and cost of medical care, and time lost from work and housekeeping. The model has been used to generate preliminary estimates of the lifetime cost of epilepsy for a cohort of persons diagnosed in 1990 in the United States. The distribution of incident cases among prognostic groups is derived from epidemiologic studies of prognosis in epilepsy. Direct cost is estimated by multiplying nationally representative unit costs by the expected type and frequency of medical care use. The latter were derived by an expert panel, based on inferences from existing literature and on their own clinical experiences. Indirect cost is estimated based on lost earnings associated with projections of restricted activity days, excess unemployment, and excess mortality. Total lifetime cost in 1990 dollars of all persons with epilepsy onset in 1990 was estimated at $3.0 billion, with indirect cost accounting for 62% of the total. Cost per patient ranged from $4,272 for persons with remission after initial diagnosis and treatment to $138,602 for persons with intractable and frequent seizures. Antiepileptic drug (AED) treatment is the most costly category of service. Different assumptions about the amount and type of drug administration cause major changes in overall cost estimates.

SUMMARYPurpose: The purpose of this study was to identify sociodemographic disparities in health care use among epilepsy patients receiving care at different sites and the extent to which the disparities persisted after adjusting for patient characteristics and site of care. Methods: Three months of health care use data were obtained from baseline interviews of approximately 560 patients at four sites. One-half of the patients were from a Houston site and two NYC sites that serve predominantly low-income, minority, publicly insured, or uninsured patients. The other half were at the remaining site in Houston that serves a more balanced racial/ethnic and higher sociodemographic population. Differences in general and specialist visits, hospital emergency room (ER) care, and hospitalizations were associated with race/ethnicity, income, and coverage.Logistic regression was used to assess the extent to which the differences persisted when adjusting for individual patient characteristics and site of care. Results: Compared to whites, blacks and Hispanics had higher rates of generalist visits [odds ratio (OR) = 5.3 and 4.9, p < 0.05), ER care (OR = 3.1 and 2.9, p < 0.05) and hospitalizations (OR = 5.4 and 6.2, p < 0.05), and lower rates of specialist visits (OR = 0.3 and 0.4, p < 0.05). A similar pattern was found related to patient income and coverage. The magnitude and significance of the disparities persisted when adjusting for individual characteristics but decreased substantially or were eliminated when site of care was added to the model. Discussion: There are sociodemographic disparities in health care for people with epilepsy that are largely explained by differences in where patients receive care. KEY WORDS: Epilepsy, Health care utilization, Disparities, Sociodemographics, Race/ethnicity.A number of studies provide evidence that minorities with epilepsy in the United States receive different amounts of health care compared to nonminority whites (see literature reviews by Szaflarski et al., 2006 and Theodore et al., 2006). This is a concern for advocates and policy makers who seek to eliminate inequalities in epilepsy care and improve the health of high-risk populations. However, there are no studies examining the extent to which the disparities can be explained by such factors as differences in individual patient characteristics or variations in provider practices. We are conducting a 1-year longitudinal study of epilepsy care at four sites, two in Houston and two in Answers to such questions are needed to help inform program administrators, providers, and policy makers of the underlying reasons for disparities so that effective strategies might be designed to reduce or eliminate them.This report describes the methods used to conduct the study and provides preliminary results based on initial baseline data from the patient sample.