Abstracts

RATIONALE: The economic impact of epilepsy has recently raised the interest of clinicians, care providers, and the pharmaceutical industry. The Episcreen Project is a multicenter longitudinal observational study of the Italian League against Epilepsy. The average cost per patient/year in the cases registered in the Episcreen database as at November 1996 was L 2726116 ($US 1767). This cost is influenced by age, type of epileptic syndrome and modality of referral to the epilepsy centre. The majority of the cost is represented by hospitalisation and diagnostic procedures leading to diagnosis of the epileptic syndrome. Aim of the present work was to evaluate the direct costs after two years of follow up in a subset of patients with partial epilepsy. METHODS: In the same population of 1215 patients with partial epilepsy (848 adults and 367 children) enrolled in our first study, we analyzed direct costs (hospital admissions, day-hospital visits, specialist visits, laboratory and instrumental examinations, drugs), after a two year follow-up period (1997-1998). Cost variables were calculated using published costs and/or national tariffs. _ RESULTS:_This analysis showed a consistent reduction of costs during follow-up, with a relative increase in cost of therapy compared with costs of hospitalisation and tests. Costs increased when: seizures remained frequent, seizures appeared during the waking state, seizures provoked sudden falls, or seizures produced recurrent status epilepticus. Patients treated with polytherapy required more resources than those in monotherapy and presence of complex partial seizures increased total costs in children. Symptomatic epilepsies also implied a higher resource consumption than cryptogenetic and idiopathic conditions. CONCLUSIONS: Our analysis showed that in partial epilepsies most of the cost derives from procedures related to diagnosis (hospitalisation and diagnostic procedures), whereas costs tend to decline during the follow-up period. Higher costs during follow-up are related to the type of epileptic syndrome, severity of seizures and need for polytherapy.