Money matters in epilepsy.

Cost of epilepsy care has escalated many folds in the recent past. The high cost of newer anti epileptic drugs, cost of elaborate presurgical evaluation and surgery account for a large component of direct medical cost. Indirect cost to the society, through lost productivity or premature death, is many times more than the direct cost. The newer drugs have an advantage over the conventional drugs in terms of tolerability, safety and ease of administration. The benefits in terms of better control of seizures and improvement in quality of life offered by these newer strategies in treatment of epilepsy need to be considered along with the increase in cost. Careful economic evaluation is essential to assess ultimate utility of these interventions in the management of epilepsy at large. Unfortunately, there is little data on this aspect for the physician to apply in his practice. The general principles of economic appraisal of epilepsy and some of the key works in this field are discussed in this paper. The increase in cost due to newer anti epileptic drugs in the treatment of unselected population of patients (mild and severe epilepsy) may not be adequately justified by gains in seizure control. On the other hand newer drugs may have a clear superiority in selected situations such as intractable seizures. The high initial cost of presurgical evaluation and epilepsy surgery may be offset by gains in increased number of quality adjusted life years.