Thomas S V
Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, India.
Neurol India. 2000 Dec;48(4):322-9.
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.
近年来，癫痫治疗费用大幅攀升。新型抗癫痫药物的高昂成本、详尽的术前评估费用以及手术费用，构成了直接医疗成本的很大一部分。因生产力损失或过早死亡给社会带来的间接成本，是直接成本的许多倍。新型药物在耐受性、安全性和给药便利性方面优于传统药物。在考虑成本增加的同时，也需要权衡这些新型癫痫治疗策略在更好地控制癫痫发作和改善生活质量方面所带来的益处。进行细致的经济评估对于全面评估这些干预措施在癫痫治疗中的最终效用至关重要。不幸的是，医生在实践中几乎没有这方面的数据可供应用。本文讨论了癫痫经济评估的一般原则以及该领域的一些关键研究成果。在治疗未经过筛选的患者群体（轻度和重度癫痫）时，新型抗癫痫药物导致的成本增加，可能无法通过癫痫发作控制方面的获益得到充分证明。另一方面，新型药物在某些特定情况下，如难治性癫痫发作，可能具有明显优势。术前评估和癫痫手术高昂的初始成本，可能会因质量调整生命年数量的增加而得到弥补。
