Direkte und indirekte Kosten aktiver Epilepsie in Deutschland und im internationalen Vergleich

Epilepsy is one of the most frequent neurological illnesses and represents a substantial load for the concerned and the society. There is nevertheless a very small number of cost studies, which are focused on the social-economic effects of epilepsy in Germany only. Therefore we accomplished a pilot study at the epilepsy center Marburg, in order to compute the direct and indirect costs of therapy-refractory epilepsy. We raised the costs and cost-driving factors at a cross section population of adult patients with active epilepsy at an epilepsy outpatient clinic . Seizure-free patients and patients with their first seizure were excluded. During an investigation period of three months the direct and indirect costs were seized prospectively by the employment of questionnaires and patient diaries. The study population covered 101 patients (40.7 +/- 15.2 years; Duration of the disease: 18,1 +/- 15.3 years). Altogether 20 patients (20%) had a idiopathic generalized epilepsy with generalized tonoclonic seizures, of the patients with a focal epilepsy 6 patients (6%)had solely single-partial, 28 complex-partial (28%) and 43 (43%) also secondarily generalized tonoclonic seizures. The total costs of the epilepsy for a patient averaged € 2610 +/- 4200 for a three month period. The direct costs contributed 38% to the total costs. The anti-convulsive medicines (€ 600 +/- 610) caused the main contribution to the direct costs, while the indirect costs were mainly due to productivity losses by early retirement (€ 780 +/-2680). As cost-driving factors frequent seizures, long duration of the disease, seizure associated falls and inadequate actions during or after the convulsions were identified. The results prove that in adult patients the indirect costs with active epilepsy were higher than the direct costs. Medicines contributed at most to the direct costs, while early retirement represented the main factor of the indirect costs . Despite the limitations comparing studies of different countries, varying study populations and different health systems a literature comparison aimed off to receive a broad overview of the cost studies with adults with epilepsy which were published since 1990. In our study the costs of therapy refractory epilepsy lay over the average of the costs of all epilepsy forms raised in Europe. The costs however did not exceed clearly. Also in this study the indirect costs outweighed in relation to the direct costs, whereby the medication represented the largest factor within the direct costs. Keywords: Disease costs - epilepsy - direct costs - indirect costs