Berto P, Tinuper P, Viaggi S
Neurological Institute, University of Bologna, Italy.
Pharmacoeconomics. 2000 Feb;17(2):197-208. doi: 10.2165/00019053-200017020-00008.
To investigate the impact of epilepsy in Italy on healthcare resources, producing an average cost per patient per year of follow-up.
The Episcreen Project is a multicentre longitudinal Italian observational study; its methodology, organisational network and case report form have been reported in detail elsewhere. Using a subset of patients with epilepsy from this project, we conducted a retrospective cost-of-illness analysis based on clinical records. The analysis was performed from the societal (community) perspective, including both direct and indirect costs. Hospital admissions, day-hospital visits, specialist visits, instrumental examinations, drugs and productivity losses because of visits and hospitalisation were analysed. Each cost variable was valued in 1996 Italian liras (L) using published national tariffs (except for drugs for which published prices were used). A sensitivity analysis was conducted on indirect costs to test the robustness of the assumption that 1 working day lost for each day hospital visit would produce a change of 0.3% in the weight of indirect costs.
Patients analysed in this study were registered in the Episcreen database as at 21 November 1996. They were diagnosed with epilepsy at the last visit, had at least 1 follow-up visit (i.e. at least 1 visit after the enrolment visit), and had at least 12 months of follow-up.
The average cost per patient per year was L2,726,116 ($US1767). The average cost per patient was higher for children than for adults [L3,629,997 ($US2353) and L2,362,134 ($US1531), respectively), and for newly diagnosed patients for whom the first diagnosis of epilepsy was addressed at the first Episcreen visit [adults: old referrals L1,304,353 ($US845), new referrals L6,901,374 ($US4473); children: old referrals L2,810,504 ($US1822), new referrals L7,814,400 ($US5065)]. Direct costs represented 87.6% of total costs. The major cost driver was hospitalisation (63.7%), followed by drugs (10.5%), day-hospital visits (4.1%), out-patient visits (3.85%), other tests (3.1%) and electroencephalographs (2.3%). Indirect costs (lost productivity) represented 12.4% of total costs. Sensitivity analysis showed that the results are sensitive to the value attributed to lost productivity.
The cost of managing a patient with epilepsy in Italy is influenced by age, syndrome and modality of referral to the centre for epilepsy.
调查意大利癫痫对医疗资源的影响，得出每位患者每年随访的平均费用。
Episcreen项目是一项意大利多中心纵向观察性研究；其方法、组织网络和病例报告表已在其他地方详细报道。我们使用该项目中癫痫患者的一个子集，基于临床记录进行了回顾性疾病成本分析。该分析从社会（社区）角度进行，包括直接和间接成本。分析了住院、日间医院就诊、专科就诊、器械检查、药物以及因就诊和住院导致的生产力损失。每个成本变量均使用已公布的国家收费标准以1996年意大利里拉（L）计价（药物除外，药物使用公布的价格）。对间接成本进行了敏感性分析，以检验以下假设的稳健性：每次日间医院就诊损失1个工作日会使间接成本权重产生0.3%的变化。
本研究分析的患者于1996年11月21日登记在Episcreen数据库中。他们在最后一次就诊时被诊断为癫痫，至少有1次随访就诊（即登记就诊后的至少1次就诊），且随访时间至少为12个月。
每位患者每年的平均费用为2,726,116里拉（1767美元）。儿童患者的平均费用高于成人[分别为3,629,997里拉（2353美元）和2,362,134里拉（1531美元）]，对于在Episcreen首次就诊时首次被诊断为癫痫的新诊断患者也是如此[成人：旧转诊患者1,304,353里拉（845美元），新转诊患者6,901,374里拉（4473美元）；儿童：旧转诊患者2,810,504里拉（1822美元），新转诊患者7,814,400里拉（5065美元）]。直接成本占总成本的87.6%。主要成本驱动因素是住院（63.7%），其次是药物（10.5%）、日间医院就诊（4.1%）、门诊就诊（3.85%）、其他检查（3.1%）和脑电图检查（2.3%）。间接成本（生产力损失）占总成本的12.4%。敏感性分析表明，结果对归因于生产力损失的价值敏感。
在意大利，癫痫患者的管理成本受年龄、综合征以及转诊至癫痫中心的方式影响。
