Geethadevi Gopisankar Mohanannair, Jensen Kristoffer Jarlov, Kwan Patrick, Foster Emma, Jackson Graeme, Chen Zhibin, Ademi Zanfina
Health Economics and Policy Evaluation Research Group, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Clayton, Victoria, Australia.
Copenhagen Phase IV Unit, Center for Clinical Research and Prevention, and Department of Clinical Pharmacology, Copenhagen University Hospital-Bispebjerg-Frederiksberg, Copenhagen, Denmark.
Epilepsia. 2025 Aug;66(8):2803-2815. doi: 10.1111/epi.18430. Epub 2025 Apr 29.
The World Health Organization's Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders calls for more epilepsy care centers, but a population-level estimate of epilepsy's projected burden to justify this investment from a societal perspective is lacking. We aimed to project the burden of epilepsy using dynamic life table modeling including number of deaths, years of life, quality-adjusted life years (QALYs), productivity-adjusted life years (PALYs), health care costs, and number of people to be screened for surgical eligibility in the Australian adult population (aged 18-80 years) from 2024 to 2033.
A dynamic model was developed to capture incident and prevalent epilepsy in Australia, using five health states: not seizure-free non-drug resistant (NSF-NDRE), seizure-free non-drug resistant (SF-NDRE), not seizure-free drug resistant (NSF-DRE), seizure-free drug-resistant (SF-DRE), and death in 1-year cycles. The inputs came from published studies, Glosgow cohort study and from the Australian Epilepsy Project.
In 10 years, 82 723 Australian adults had incident epilepsy, whereas 125 223 formed the prevalent cohort. Over 10 years, the epilepsy population experienced 15 227 deaths and accrued 1 209 280 years of life, distributed as 23.6% NSF-NDRE, 58.3% SF-NDRE, 15.8% NSF-DRE, and 2.1% SF-DRE. The population accrued 992 812 QALYs and 442 600 PALYs. Total health care costs reached $14.2 billion US dollars (USD), of which NSF-DRE contributed 35%. Uncontrolled seizures resulted in the loss of 84 881 QALYs, 19 333 PALYs, $4.5 billion USD, and 4603 lives. A total of 10 665 individuals were eligible for surgical evaluation, with an additional 383 projected annually through 2033.
This dynamic life table model, based on the current standard of care for epilepsy, demonstrates quality of life impact, productivity loss, and cost burden due to uncontrolled seizures and drug resistance, supporting the need for further investment in epilepsy care. This approach can be applied to other countries to inform policy decisions in epilepsy from a societal perspective.
世界卫生组织《癫痫及其他神经疾病部门间全球行动计划》呼吁设立更多癫痫护理中心，但从社会角度来看，目前缺乏对癫痫预计负担的人群水平评估，以证明这项投资的合理性。我们旨在通过动态生命表模型预测癫痫负担，该模型包括死亡人数、生命年数、质量调整生命年（QALY）、生产力调整生命年（PALY）、医疗保健成本，以及2024年至2033年澳大利亚成年人口（18 - 80岁）中需接受手术资格筛查的人数。
开发了一个动态模型来捕捉澳大利亚的癫痫发病率和患病率，使用五个健康状态：未无发作非耐药（NSF - NDRE）、无发作非耐药（SF - NDRE）、未无发作耐药（NSF - DRE）、无发作耐药（SF - DRE）以及死亡，以1年为周期。输入数据来自已发表的研究、格拉斯哥队列研究和澳大利亚癫痫项目。
在10年中，82723名澳大利亚成年人患有癫痫，而125223人构成了现患队列。在10年期间，癫痫患者群体经历了15227例死亡，累积了1209280个生命年，分布情况为23.6%为NSF - NDRE、58.3%为SF - NDRE、15.8%为NSF - DRE、2.1%为SF - DRE。该群体累积了992812个QALY和442600个PALY。医疗保健总成本达到142亿美元，其中NSF - DRE占35%。未控制的癫痫发作导致损失84881个QALY（伤残调整生命年）、19333个PALY、45亿美元和4603条生命。共有10665人符合手术评估条件，到2033年预计每年还会新增383人。
这个基于当前癫痫护理标准的动态生命表模型，展示了未控制的癫痫发作和耐药性对生活质量、生产力损失以及成本负担的影响，支持了对癫痫护理进一步投资的必要性。这种方法可应用于其他国家，从社会角度为癫痫相关政策决策提供参考。
