A review of the costs of managing childhood epilepsy.

Epilepsy is a chronic treatable condition for which new diagnostic tools and several new drugs and non-pharmacological treatments are now available. The cost profile of these options is assessed here through an overview of the available literature focusing on studies of childhood epilepsy. Several methodological problems arise when interpreting the results of economic studies in epilepsy, including the variability of the study population and costs items, the reliability of the sources of cost, the limitations of the methods of data collection and the deficiencies of the study designs, with reference to the measures of treatment benefits. International comparisons are then difficult because economic results cannot be compared on account of differences in monetary issues, clinical practice patterns and healthcare system frameworks. The economic aspects of epilepsy are different in children and adults. Differences are detectable in the incidence and expression of epileptic syndromes, social and emotional impact, availability of antiepileptic drugs, hospital admissions, diagnostic tests and referral to specialists, social assistants and other healthcare professionals. In addition, children have access to medical services only with the help of a caregiver, for whom there may be lost work days or under-employment. The mean annual cost per child with epilepsy was USD 1853 for controlled epilepsy and USD 4950 for uncontrolled epilepsy in a Spanish study performed in 1998 and the annual direct costs per child with epilepsy ranged from euro 844 for patients in remission to euro 3268 for patients with drug-resistant epilepsy in an Italian study done between 1996 and 1998. The Spanish study showed that direct costs are the major source of expenditure for children with epilepsy. These studies along with a number of other cost-of-illness studies in combined populations of adults and children showed that service use and costs increase with more severe forms of illness and seizure frequency, this being more marked in adults than in children. Moderate cost differences may be expected between children (higher) and adults (lower), particularly with reference to initial investigations. Costs of epilepsy are mostly explained by hospital admissions and drugs; in particular, drug costs tend to dominate in more well controlled epilepsy, while both hospital admissions and drugs are significant costs in less well controlled epilepsy. Newly diagnosed patients can incur significant hospital and diagnostic costs. Costs for epilepsy tend to be lower for patients cared for in general practice or outpatient settings than in hospital settings. Seizure control by drugs, ketogenic diet or surgery is associated with a significant reduction in the costs of epilepsy.