Boccaletti Simona, Lucas Eleanor, Nixon Annabel, Boskovic Nikolina, Di Dato Giorgio
Angelini Pharma, Rome, Italy.
OPEN Health, Bethesda, Maryland, USA.
Epilepsia Open. 2024 Dec;9(6):2055-2086. doi: 10.1002/epi4.13011. Epub 2024 Sep 18.
This systematic literature review (SLR) assessed the humanistic and economic burden of focal epilepsy and primary generalized tonic-clonic seizures (PGTCS) in adults to evaluate these domains in both populations and identify evidence gaps to inform future research. A search was conducted on December 7, 2022, using MEDLINE and Embase to identify studies published from 2012 onwards reporting humanistic burden (patient-reported or caregiver-reported outcomes or utilities, qualitative evaluations), economic burden (productivity loss, caregiver and societal costs of epilepsy), and sleep-related outcomes. Of the 2830 citations identified, 136 were included. Most studies were in the focal epilepsy population; very few studies reported outcomes in the PGTCS population. The presence of epilepsy-specific instruments varied based on the domain evaluated. Epilepsy exerted considerable humanistic and economic burden. Indicators of poor disease control (e.g., high seizure frequency, resistance to anti-seizure medications, polypharmacy) increased epilepsy burden. Seizure frequency and type, disease severity, and polypharmacy also affected work productivity. Adults with epilepsy, particularly focal epilepsy, reported higher indirect costs, more sick days accrued, and early entry into retirement. Caregivers similarly reported high productivity loss and absenteeism related to caregiving duties. The results of this SLR highlight the high humanistic and economic burden of focal epilepsy and PGTCS, although limited data were available for the PGTCS population. The results include patient-reported outcome data specific to focal epilepsy and PGTCS, expanding the limited humanistic burden evidence identified in previous reviews, and show the effect of poor disease control on individuals' lives and as a driver of indirect costs. PLAIN LANGUAGE SUMMARY: Our systematic literature review identified studies that evaluated the impact of focal epilepsy and primary generalized tonic-clonic seizures on patients and their caregivers. We found that focal epilepsy negatively impacted patients' mental health and sleep and was associated with higher indirect costs and lower work productivity in people with more severe disease. The impact of primary generalized tonic-clonic seizures on patients was rarely reported, and future research is needed.
本系统文献综述(SLR)评估了成人局灶性癫痫和原发性全面性强直阵挛发作(PGTCS)的人文负担和经济负担,以评估这两类人群在这些方面的情况,并找出证据空白,为未来研究提供参考。2022年12月7日,利用MEDLINE和Embase进行了检索,以确定2012年以来发表的报告人文负担(患者报告或照料者报告的结果或效用、定性评估)、经济负担(生产力损失、癫痫的照料者和社会成本)以及睡眠相关结果的研究。在检索到的2830篇文献中,纳入了136篇。大多数研究针对局灶性癫痫人群;很少有研究报告PGTCS人群的结果。癫痫特异性工具的存在因评估领域而异。癫痫造成了相当大的人文和经济负担。疾病控制不佳的指标(如癫痫发作频率高、对抗癫痫药物耐药、联合用药)增加了癫痫负担。癫痫发作频率和类型、疾病严重程度以及联合用药也影响工作生产力。患有癫痫的成年人,尤其是局灶性癫痫患者,报告的间接成本更高、累积病假更多且提前退休。照料者同样报告了与照料职责相关的高生产力损失和缺勤情况。本SLR的结果突出了局灶性癫痫和PGTCS的高人文和经济负担,尽管PGTCS人群的数据有限。结果包括局灶性癫痫和PGTCS特有的患者报告结局数据,扩展了先前综述中确定的有限的人文负担证据,并显示了疾病控制不佳对个人生活的影响以及作为间接成本驱动因素的作用。通俗易懂的总结:我们的系统文献综述确定了评估局灶性癫痫和原发性全面性强直阵挛发作对患者及其照料者影响的研究。我们发现,局灶性癫痫对患者的心理健康和睡眠产生负面影响,并且与病情较重者的更高间接成本和更低工作生产力相关。原发性全面性强直阵挛发作对患者的影响很少有报告,需要未来的研究。
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