Hamer Hajo M, Spottke Annika, Aletsee Christiane, Knake Susanne, Reis Janine, Strzelczyk Adam, Oertel Wolfgang H, Rosenow Felix, Dodel Richard
Department of Neurology, Philipps-University, Marburg, Germany.
Epilepsia. 2006 Dec;47(12):2165-72. doi: 10.1111/j.1528-1167.2006.00889.x.
There are only few studies on the costs of epilepsy in Germany. Therefore, we performed a pilot study to estimate the direct and indirect costs of refractory epilepsy in a German epilepsy center.
A "prevalence-based," cross-sectional convenience sample of adults with active epilepsy attending the outpatient clinic of our tertiary epilepsy center was evaluated. Seizure-free patients and patients presenting with their first seizure were excluded. Direct and indirect costs were prospectively recorded over a three-month period using questionnaires and a patient diary. Cost driving factors were identified.
One hundred one patients were included (40.7+/-15.2 years; disease duration: 18.1+/-15.3 years; 6 patients had focal epilepsy with simple partial seizures only, 28 with complex partial seizures, 43 with secondarily generalized tonic-clonic seizures; 20 had idiopathic generalized epilepsy with generalized tonic-clonic seizures). The total costs of epilepsy per patient were in average euro 2610+/-4200 over the three-month period. Direct cost contributed 39% to the total costs. Costs of anticonvulsant medication were the main contributor to the direct costs while indirect costs were caused mainly by losses due to early retirement. Cost driving factors included higher seizure frequency, longer disease duration, ictal falls, and situationally inappropriate complex behavior during or after the seizure.
Indirect costs were higher than direct costs in adult patients with active epilepsy attending a German epilepsy center. Medication contributed the most to the direct costs and early retirement was the main factor for the indirect costs. The costs of poorly controlled epilepsy in this German study were above average of the European costs of epilepsy.
德国仅有少数关于癫痫成本的研究。因此，我们开展了一项试点研究，以估算德国一家癫痫中心难治性癫痫的直接和间接成本。
对在我们三级癫痫中心门诊就诊的活动性癫痫成年患者进行了一项基于患病率的横断面便利抽样评估。无癫痫发作的患者和首次发作的患者被排除。使用问卷和患者日记前瞻性记录三个月期间的直接和间接成本。确定成本驱动因素。
纳入101例患者（年龄40.7±15.2岁；病程18.1±15.3年；6例仅患有局灶性癫痫伴单纯部分性发作，28例患有复杂部分性发作，43例患有继发性全身性强直 - 阵挛发作；20例患有特发性全身性癫痫伴全身性强直 - 阵挛发作）。在三个月期间，每位患者的癫痫总成本平均为2610±4200欧元。直接成本占总成本的39%。抗惊厥药物成本是直接成本的主要贡献者，而间接成本主要由提前退休造成的损失引起。成本驱动因素包括癫痫发作频率较高、病程较长、发作期跌倒以及发作期间或之后出现的情境不适当的复杂行为。
在德国一家癫痫中心就诊的活动性癫痫成年患者中，间接成本高于直接成本。药物对直接成本的贡献最大，提前退休是间接成本的主要因素。在这项德国研究中，癫痫控制不佳的成本高于欧洲癫痫成本的平均水平。
