The burden of epilepsy to patients and payers.

The extraordinary burden of epilepsy on quality of life (QOL) is well known, as is the very high economic burden associated with the disease. Epilepsy is associated not only with seizures, but also a variety of serious comorbidities, including respiratory, cardiovascular, and neurologic dysfunctions. Psychiatric conditions are very prevalent in the epilepsy population, and may have pathological mechanisms in common with epilepsy. Compared with healthy controls, patients with untreated epilepsy have scored significantly worse across a spectrum of neurocognitive tests. Patients with epilepsy and comorbidities-neurocognitive or otherwise-engage in higher rates of healthcare utilization than those without comorbidities. This, in part, explains why approximately 80% of overall medical costs for patients with epilepsy are for non-epilepsy-related care. The key driver of direct costs in epilepsy is medical service expenditures. For uncontrolled seizure disorders, this becomes even more problematic as medical service use increases. At the same time, the proportional cost of antiepileptic medications decreases as other costs escalate. Although the direct costs of epilepsy are substantial, the overwhelming majority of total costs, as much as 86%, are attributable to indirect costs such as job absenteeism. Ultimately, the burden of epilepsy for patients, in terms of severely reduced QOL, and for payers, in terms of both direct and indirect costs, would be best addressed and reduced by achieving optimal control of seizures.