Analysis Group, Inc., New York, NY 10020, USA.
Pharmacoeconomics. 2010;28(8):675-85. doi: 10.2165/11535570-000000000-00000.
The direct cost burden of epilepsy in the US from a third-party payer perspective has not been evaluated. Furthermore, no study has quantified the indirect (work-loss) cost burden of epilepsy from an employer perspective in the US.
To assess the annual direct costs for privately insured US patients diagnosed with epilepsy, and indirect costs for a subset of employees from an employer perspective.
A retrospective analysis of a claims database for the privately insured, including employee disability claims from 1999 through 2005 and comprising 17 US companies, was conducted. A total of 4323 patients aged 16-64 years (including 1886 employees) with at least one epilepsy diagnosis (International Classification of Diseases, 9th edition, Clinical Modification [ICD-9-CM] code 345.x) over the period 1999-2004 were included. The control group was a demographically matched cohort of randomly chosen beneficiaries without an epilepsy diagnosis. All had continuous health coverage during 2004 (baseline) and 2005 (study period). Main outcome measures included annual direct (medical and pharmaceutical) costs and, for employees, indirect (disability and medically related absenteeism) and total costs for the study period. Wilcoxon rank-sum tests were used for univariate comparisons of annual direct costs, indirect costs (costs for the subset of employees with these data), and total (direct and indirect) costs during the study period. Two-part multivariate models that adjusted for patient characteristics were also used to compare costs between the study and control groups.
Patients with epilepsy were an average age of 43 years and 57% were female. They had more co-morbidities than controls. On average, direct annual costs were significantly higher per patient with epilepsy than per control ($US10 258 vs $US3862, respectively; p < 0.0001) [year 2005 values], with an annual per-patient difference of $US6396. Epilepsy-related costs ($US2057) accounted for 20% of direct costs for patients with epilepsy. Annual indirect costs were significantly higher for employees with epilepsy than for employed controls ($US3192 vs $US1242, respectively; p < 0.0001), with a difference of $US1950. Total direct plus indirect costs for employees with epilepsy were also higher than those for employed controls ($US13 595 vs $US5338, respectively; p < 0.0001), with a difference of $US8257.
Epilepsy was associated with significant economic burden. The excess direct costs in patients with epilepsy are underestimated when only epilepsy-related costs are considered.
从第三方支付者的角度来看，美国癫痫的直接费用负担尚未得到评估。此外，从雇主的角度来看，在美国，还没有研究对癫痫的间接（工作损失）成本负担进行量化。
评估美国私人保险患者的年度直接费用，以及从雇主角度来看，部分员工的间接费用。
对 1999 年至 2005 年期间的私人保险索赔数据库进行了回顾性分析，包括来自 17 家美国公司的员工残疾索赔，共纳入 4323 名年龄在 16-64 岁（包括 1886 名员工）的至少有一次癫痫诊断（国际疾病分类，第 9 版，临床修正版[ICD-9-CM]代码 345.x）的患者。对照组是一个随机选择的、无癫痫诊断的受益人群，他们在 2004 年（基线）和 2005 年（研究期）期间均有连续的健康保险。主要观察指标包括研究期间的年度直接（医疗和药品）费用和员工的间接（残疾和与医疗相关的旷工）和总费用。采用 Wilcoxon 秩和检验对研究期间的年度直接费用、间接费用（有这些数据的员工子集的费用）和总费用（直接和间接）进行单变量比较。还使用了调整患者特征的两部分多变量模型来比较研究组和对照组之间的费用。
癫痫患者的平均年龄为 43 岁，57%为女性。他们比对照组有更多的合并症。平均而言，癫痫患者的年度直接费用明显高于对照组（分别为$US10258 与$US3862；p<0.0001）[2005 年数值]，每人每年相差$US6396。癫痫相关费用（$US2057）占癫痫患者直接费用的 20%。癫痫患者的年度间接费用明显高于有工作的对照组（分别为$US3192 与$US1242；p<0.0001），相差$US1950。癫痫患者的直接加间接总费用也高于有工作的对照组（分别为$US13595 与$US5338；p<0.0001），相差$US8257。
癫痫与显著的经济负担有关。仅考虑癫痫相关费用时，癫痫患者的额外直接费用被低估了。
