Tetto A, Manzoni P, Millul A, Beghi Ettore, Garattini L, Tartara A, Avanzini G
Centro per l'Epilessia e Clinica Neurologica, Ospedale "San Gerardo", Monza, Italy.
Epilepsy Res. 2002 Feb;48(3):207-16. doi: 10.1016/s0920-1211(02)00013-x.
[corrected] Epilepsy poses a considerable economic burden on society. However, information is insufficient on the comparative costs of different disease varieties. The purpose of this study was to compare the direct costs of epilepsy in referral patients with disease of different severity and duration.
Patients with newly diagnosed epilepsy (NDE), seizure remission (SR), occasional seizures (OS), frequent non-drug-resistant (NDR) and drug-resistant (DR) seizures, and surgical candidates (SC) from 14 epilepsy centers were the target population. All patients were followed prospectively for 12 months and all medical and paramedical contacts for diagnostic and therapeutic services were noted with details, using ad-hoc diaries and semistructured questionnaires.
The study population comprised 525 consecutive children and adults with partial (68%), generalized (25%) and undetermined epilepsy (4%) as follows: NDE 70; SR 131; OS 108; NDR 101; DR 107; SC 8. Ambulatory visits (mean 2.8 per patient per year) were the leading service in all groups, followed by EEG recordings (1.8) and biochemical assays (1.1). At entry, the commonest drugs were carbamazepine (50%), valproate (37%), phenobarbital (21%), vigabatrin (14%) and lamotrigine (11%). New antiepileptic drugs (AED) were used increasingly with the severity of the disease. The total annual costs varied significantly across groups: 3945 Euro (SC), 2198 Euro (DR), 1626 Euro (NDR), 1002 Euro (NDE), 558 Euro (OS), 412 Euro (SR). The main item of expenditure was hospital stay (including day-hospital), followed by drug treatment and outpatient visits. The costs of outpatient services, hospital services and drugs varied significantly across groups.
The direct costs of epilepsy vary significantly depending on the severity of the disease and the response to treatment. Hospital admissions and drugs are the commonest items of expenditure.
癫痫给社会带来了相当大的经济负担。然而，关于不同疾病类型的比较成本信息不足。本研究的目的是比较不同严重程度和病程的转诊癫痫患者的直接成本。
来自14个癫痫中心的新诊断癫痫（NDE）、癫痫发作缓解（SR）、偶发癫痫（OS）、频繁非耐药（NDR）和耐药（DR）癫痫发作以及手术候选者（SC）患者为目标人群。所有患者前瞻性随访12个月，使用特制日记和半结构化问卷详细记录所有诊断和治疗服务的医疗及辅助医疗接触情况。
研究人群包括525例连续的儿童和成人，其中部分性癫痫（68%）、全身性癫痫（25%）和未定型癫痫（4%）如下：NDE 70例；SR 131例；OS 108例；NDR 101例；DR 107例；SC 8例。门诊就诊（平均每人每年2.8次）是所有组中最主要的服务项目，其次是脑电图记录（1.8次）和生化检测（1.1次）。入院时，最常用的药物是卡马西平（50%）、丙戊酸盐（37%）、苯巴比妥（21%）、氨己烯酸（14%）和拉莫三嗪（11%）。新型抗癫痫药物（AED）的使用随着疾病严重程度的增加而增多。各组的年度总成本差异显著：3945欧元（SC）、2198欧元（DR）、1626欧元（NDR）、1002欧元（NDE）、558欧元（OS）、412欧元（SR）。主要支出项目是住院（包括日间医院），其次是药物治疗和门诊就诊。门诊服务、住院服务和药物的成本在各组之间差异显著。
癫痫的直接成本因疾病严重程度和治疗反应而异。住院和药物是最常见的支出项目。
