Evaluation of costs of epilepsy using an electronic practice management software in Germany

Noda, Antonio Sedeño; Hermsen, A.; Berkenfeld, Ralf; Dennig, Dieter; Endrass, Günther; Kaltofen, J; Safavi, Ali; Wiehler, Stephan; Carl, Gunther; Meier, Uwe; Elger, Christian E.; Menzler, Katja; Knake, Susanne; Rosenow, Felix; Strzelczyk, Adam

doi:10.1016/j.seizure.2015.01.010

Cited by 24 publications

(10 citation statements)

References 45 publications

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“…We could also demonstrate a decrease in carbamazepine prescriptions as the mainly used strong enzyme-inducing AEDs. This is consistent with other European and German studies [33,[37][38][39][40] on prescription patterns in epilepsy that show a strong trend in favor of non-enzyme-inducing drugs.…”

Section: Discussionsupporting

confidence: 92%

Guideline conform initial monotherapy increases in patients with focal epilepsy: A population-based study on German health insurance data

Ertl¹,

Hapfelmeier²,

Peckmann

et al. 2016

Seizure

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Section: Discussionsupporting

confidence: 92%

Guideline conform initial monotherapy increases in patients with focal epilepsy: A population-based study on German health insurance data

Ertl¹,

Hapfelmeier²,

Peckmann

et al. 2016

Seizure

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“…Our cost calculations were consistent with previous COI studies, which estimated that over 1 year (prevalence based), the direct medical costs related to epilepsy mainly involved the costs of return visits and long-term therapy [17]. A total annual cost of €1698 ($1919) per patient with active epilepsy treated in private neurological offices was reported in Germany [17], whereas the highest annual cost for this patient group was found in the US, at up to $13,787 [8]. Because we are not dealing with chronic epilepsy, the costs of the first seizure work-up are lower.…”

Section: Discussionsupporting

confidence: 88%

“…Both systematic reviews and cost-of-illness (COI) studies have reported a consistent pattern of markedly higher costs associated with those with uncontrolled or refractory epilepsy [1]. Our cost calculations were consistent with previous COI studies, which estimated that over 1 year (prevalence based), the direct medical costs related to epilepsy mainly involved the costs of return visits and long-term therapy [17]. A total annual cost of €1698 ($1919) per patient with active epilepsy treated in private neurological offices was reported in Germany [17], whereas the highest annual cost for this patient group was found in the US, at up to $13,787 [8].…”

Section: Discussionsupporting

confidence: 87%

Early specialized care after a first unprovoked epileptic seizure

Fisch¹,

Lascano²,

Vernaz

et al. 2016

J Neurol

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A first seizure is a life-changing event with physical and psychological consequences. We aimed to assess the role of early comprehensive patient care after a first unprovoked seizure to improve diagnostic accuracy and follow-up adherence. From April 2011 to March 2012, patients presenting a first unprovoked epileptic seizure received standard patient care (SPC), i.e., a consultation in the ED, an EEG and a CT scan. The patients were notified of the follow-ups. We compared this protocol to subsequently acquired "early comprehensive patient care" (ECPC), which included a consultation by an epileptologist in the emergency department (ED), a routine or long-term monitoring electroencephalogram (LTM-EEG), magnetic resonance imaging and three follow-up consultations (3 weeks, 3 months, 12 months). 183 patients were included (113 ECPC, 70 SPC). LTM-EEG and MRI were performed in 51 and 85 %, respectively, of the patients in the ECPC group vs in 7 and 52 % of the patients in the SPC group (p < 0.001). A final diagnosis was obtained in 64 vs 43 % of the patients in the ECPC vs SPC group (p < 0.01). Patient attendance at 3-month was 84 % in the ECPC group vs 44 % in the SPC group (p < 0.001). At 12-month follow-up, the delay until the first recurrence was longer in the ECPC group (p = 0.008). An early epileptologist-driven protocol is associated with clinical benefit in terms of diagnostic accuracy, follow-up adherence and recurrence. This study highlights the need for epilepsy experts in the early assessment of a first epileptic seizure, starting already in the ED.

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“…The study has also confirmed findings from other studies on prescription patterns in drug-refractory patients who used a top-down approach ( 38 – 40 ). Comparison of these prescription patterns with previous German studies carried out in 2003 ( 15 ), 2008 ( 18 ), 2009 ( 38 ), 2011 ( 8 , 41 ), and 2012 ( 9 ) show a significant increase in the use of “newer” AEDs and a marked reduction in enzyme-inducing anticonvulsant prescriptions. Since 2008, German guidelines recommend that the first choice for monotherapy in focal epilepsy should be lamotrigine or levetiracetam and that anticonvulsants with drug–drug interactions should not be used.…”

Section: Discussionmentioning

confidence: 50%

The Burden of Severely Drug-Refractory Epilepsy: A Comparative Longitudinal Evaluation of Mortality, Morbidity, Resource Use, and Cost Using German Health Insurance Data

Strzelczyk

Griebel²,

Lux³

et al. 2017

Front. Neurol.

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113

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PurposeTo evaluate long-term outcome of three years and treatment patterns of patients suffering from severely drug-refractory epilepsy (SDRE).MethodsThis analysis was population-based and retrospective, with data collected from four million individuals insured by statutory German health insurance. ICD-10 codes for epilepsy (G40*) and intake of anticonvulsants were used to identify prevalent cases, which were then compared with a matched cohort drawn from the population at large. Insurance data were available from 2008 to 2013. Any patient who had been prescribed with at least four different antiepileptic drugs (AEDs) in an 18-month period was defined as an SDRE case.ResultsA total of 769 patients with SDRE were identified. Of these, 19% were children and adolescents; the overall mean age was 42.3 years, 45.4% were female and 54.6% male. An average of 2.7 AEDs per patient was prescribed during the first follow-up year. The AEDs most commonly prescribed were: levetiracetam (53.5%), lamotrigine (41.4%), valproate (41.3%), lacosamide (20.4%), and topiramate (17.8%). During 3-year follow-up, there was an annual rate of hospitalization in the range 42.7 to 55%, which was significantly higher than the 11.6–12.8% (p < 0.001) for the matched controls. Admissions to hospital because of epilepsy ranged between 1.7 and 1.9 per year, with an average duration for each epilepsy-caused hospitalization of 10–11.1 days. The number of comorbidities for SDRE patients was significantly increased compared with the matched controls: depression (28% against 10%), vascular disorders (22% against 5%), and injury rates were also higher (head 16% against 3%, trunk and limbs 16% against 8%). The 3-year mortality rate for SDRE patients was 14% against 2.1% in the matched cohort.ConclusionSDRE patients are treated with AED polytherapy for all of the 3-year follow-up period. They are hospitalized more frequently than the general population and show increased morbidity levels and a sevenfold increase in mortality rate over 3 years. Further examination is required of ways in which new approaches to treatment could lead to better outcomes in severely affected patients.

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Evaluation of costs of epilepsy using an electronic practice management software in Germany

Cited by 24 publications

References 45 publications

Guideline conform initial monotherapy increases in patients with focal epilepsy: A population-based study on German health insurance data

Guideline conform initial monotherapy increases in patients with focal epilepsy: A population-based study on German health insurance data

Early specialized care after a first unprovoked epileptic seizure

The Burden of Severely Drug-Refractory Epilepsy: A Comparative Longitudinal Evaluation of Mortality, Morbidity, Resource Use, and Cost Using German Health Insurance Data

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