Gesundheitsbezogene Lebensqualität und Kosten bei Patienten mit Tourette-Syndrom

Health-related Quality of Life and Costs in Patients with Gilles de la Tourette syndrome. Abstract Objective: To investigate the health-related quality of life (QOL) and to evaluate the health economic burden of patients with Gilles de la Tourette syndrome (GTS) in Germany over a 3-month observation period. Study design and methods: QOL and direct/indirect costs were evaluated in two hundred out-patients with GTS (mean age 35.0 ± 11.5 years). Patients were recruited from three out-patient departments for psychiatric disorders in Germany and completed a semi-structured and self-rating interview. The QOL was measured with the EQ-5D; depression was evaluated using the Beck’s Depression Inventory (BDI), clinical symptoms were assessed with the Shapiro-Tourette-Syndrome-Severity-Scale (STSSS). Appropriate economic data were provided in a patient diary over a 3-month period. Costs were obtained from various German medical economic resources. Costs were analysed from the point of view of healthcare and transfer payment providers and the individual patient. Indirect costs as lost productivity were also calculated. Costs were in year 2006–07 values. Multivariate regression analyses were performed to identify independent cost and QOL predictors. Results: Patients with GTS proved a worse QOL than a general population sample of Germany. The EQ VAS was 65,4 ± 22,0 (Median 70). Problems were noted in Anxiety/Depression 56.8%, followed by Pain/Discomfort 47.2%, usual activities 38.0%, mobility 14.1% and Self-Care 6.6%. The evaluation of the BDI showed an increased depressive status (mean: 13.1; standard deviation= SD 10.6) compared to a healthy control group 6.5 (SD 5.2). The STSSS was 3.3 ± 1.1. From the point of view of the statutory health insurance (Gesetzliche Kranken¬versicherung [GKV]) the costs were made up of direct medical costs €635,2 ± 17157,2, including rehabilitation €98.7 (SD 993.6), hospitalisation €195.8 (SD 1267.8), outpatient treatment €26,7 (SD 82,0) and ancillary treatment €51.9 ± 137.4. In addition, drug costs were €351, 3 ± 497, 1. The indirect medical costs amounted to €2.511,3 (SD 3.809,4) due to productivity loss and sick leave (€220,0 ± 1092,0). Individual payments of the patients were €11.8 ± 14.1. Conclusions: QOL is considerably reduced in patients with GTS. The main independent factors for determining QOL were depression, severity of symptoms and age. Although treatment of tics is important, co-morbidities such as depression should be diagnosed and treated vigorously. The costs for society are high and are mainly caused by drug treatment and indirect costs. Further studies evaluating healthcare services in Germany for patients with Tourette syndrome as well as other chronic neurologic disorders are necessary.