Unidad Multidisciplinar de Epilepsia, Servicio de Neurología, Hospital Universitario y Politécnico La Fe, Valencia, España.
Neurologia. 2013 May;28(4):195-204. doi: 10.1016/j.nrl.2012.04.012. Epub 2012 Jun 27.
Despite use of currently available anti-epileptic drugs (AED), 30% of epilepsy patients are not seizure-free. The purpose of this study was to estimate the quality of life and economic impact in Spain of drug-resistant epilepsy (DRE), as defined by the International League Against Epilepsy (ILAE).
Observational retrospective 12-month study conducted in Spain including adults with focal epilepsy treated with at least two AEDs. Direct costs (€ 2010) were calculated based on health care resources used and their official unit costs. Costs were analysed from the perspectives of the Spanish National Health System (SNS) and society. The impact of DRE on patients' quality of life was examined using the QOLIE 31-P, EQ-5D-3L, and NDDIE questionnaires.
We analysed 263 patients out of the 304 recruited. According to ILAE criteria, 70.0% of the patients had drug-resistant epilepsy, while 20.3% achieved seizure freedom. From the viewpoint of the SNS, annual costs for resistant and seizure-free patients were € 4964 and € 2978 respectively (P<.01). Compared to resistant patients, seizure-free patients showed better scores on QOLIE-31P (70.8 vs 56.4, P<.0001) and EQ-5D-3L (75.6 vs 64.7, P<.001). Seizure-free patients showed a lower incidence of major depression compared to resistant patients according to the NDDIE scale (23 vs 8.3%, P<.05).
Results suggest that DRE is associated with increased use of healthcare resources and consequently with higher costs, poorer quality of life and higher incidence of major depression compared to seizure-free patients, thus representing a considerable burden to the SNS and society.
尽管使用了目前可用的抗癫痫药物（AED），但仍有 30%的癫痫患者没有无癫痫发作。本研究的目的是根据国际抗癫痫联盟（ILAE）的定义，评估西班牙耐药性癫痫（DRE）患者的生活质量和经济影响。
在西班牙进行了一项为期 12 个月的观察性回顾性研究，纳入了接受至少两种 AED 治疗的局灶性癫痫成人患者。根据使用的卫生保健资源及其官方单位成本计算直接成本（2010 欧元）。从西班牙国家卫生系统（SNS）和社会的角度分析了成本。使用 QOLIE 31-P、EQ-5D-3L 和 NDDIE 问卷评估 DRE 对患者生活质量的影响。
在招募的 304 名患者中，我们分析了 263 名患者。根据 ILAE 标准，70.0%的患者患有耐药性癫痫，而 20.3%的患者实现了无癫痫发作。从 SNS 的角度来看，耐药和无癫痫发作患者的年成本分别为 4964 欧元和 2978 欧元（P<.01）。与耐药患者相比，无癫痫发作患者在 QOLIE-31P（70.8 与 56.4，P<.0001）和 EQ-5D-3L（75.6 与 64.7，P<.001）方面的评分更好。根据 NDDIE 量表，无癫痫发作患者的重度抑郁发生率低于耐药患者（23%与 8.3%，P<.05）。
结果表明，与无癫痫发作患者相比，DRE 与更多的卫生保健资源使用相关，因此与更高的成本、更差的生活质量和更高的重度抑郁发生率相关，从而对 SNS 和社会构成了相当大的负担。
