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The purpose of this paper is to describe the temporal pattern of healthcare cost in two population-based samples of new cases of epilepsy from two different regions of the US, and show how it varies with seizure type and frequency. Epilepsy-related healthcare cost from onset through 4 years of follow-up was determined for two population-based incident samples from Houston, TX and Rochester, MN. Cases were identified over the period 1987-1991 and followed through 1994. Annual use and cost was calculated for the first through fourth year of treatment for each person in the combined samples to examine the temporal pattern of early treatment cost. A multivariate model was estimated to examine how seizure type and seizure frequency affect early treatment cost while controlling for location, age, gender, and ethnicity. Our estimates indicate high initial healthcare cost at onset for most patients followed by lower cost in subsequent years. The mean annual epilepsy-related healthcare cost per patient was $3157 for the first year, $702 for the second year, $471 for year three, and $411 for year four. Cost was significantly higher for groups whose seizures continued and were relatively frequent, but was not significantly different for groups with partial seizures as compared with primary generalized seizures. There was a 2.2-fold difference in 4-year cost between patients with a single seizure at onset and those having recurrent seizures at the rate of more than one per month, controlling for seizure type, age, gender, and ethnicity.

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PURPOSE: To provide 1995 estimates of the lifetime and annual cost of epilepsy in the United States using data from patients with epilepsy, and adjusting for the effects of comorbidities and socioeconomic conditions. METHODS: Direct treatment-related costs of epilepsy from onset through 6 years were derived from billing and medical chart data for 608 population-based incident cases at two sites in different regions of the country. Indirect productivity-related costs were derived from a survey of 1,168 adult patients visiting regional treatment centers. Direct costs separate the effects of epilepsy and comorbidity conditions. Indirect costs account for the effects of other disabilities and socioeconomic conditions on foregone earnings and household activity. The estimates were applied to 1995 population figures to derive national projections of the lifetime and annual costs of the disorder. RESULTS: The lifetime cost of epilepsy for an estimated 181,000 people with onset in 1995 is projected at $11.1 billion, and the annual cost for the estimated 2.3 million prevalent cases is estimated at $12.5 billion. Indirect costs account for 85% of the total and, with direct costs, are concentrated in people with intractable epilepsy. CONCLUSIONS: Direct costs attributable to epilepsy are below previous estimates. Indirect costs adjusted for the socioeconomic conditions of patients are above previous estimates. Findings indicate that epilepsy is unique in the large proportion of costs that are productivity-related, justifying further investment in the development of effective interventions.

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Changes in treatment alternatives and the emphasis on cost containment and managed care have increased the interest in information on the cost of epilepsy. The last comprehensive cost study in the USA was in 1975. That study estimated the national cost of epilepsy at $3.6 billion for 2.1 million cases. On a per patient basis the 1975 figure represents $7440 in 1995 US dollars, $1150 (15%) for direct treatment-related costs and $6290 (85%) for indirect employment-related costs. Since then, various cost-of-illness (COI) studies in the USA and other countries have offered estimates ranging from $6000 to $15000 per patient per year, with percentages of direct and indirect cost varying greatly. To assist those interested in interpreting or producing cost information, this paper reviews the state of research on the cost of epilepsy and discusses several methodological issues. A comprehensive study begun in 1993 to update the 1975 estimates for the USA is also described. Recommendations are provided to stimulate discussion about the best methods to use in future research.

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A model of the clinical course of epilepsy from onset until remission or death has been developed for six prognostic groups, including survival, use and cost of medical care, and time lost from work and housekeeping. The model has been used to generate preliminary estimates of the lifetime cost of epilepsy for a cohort of persons diagnosed in 1990 in the United States. The distribution of incident cases among prognostic groups is derived from epidemiologic studies of prognosis in epilepsy. Direct cost is estimated by multiplying nationally representative unit costs by the expected type and frequency of medical care use. The latter were derived by an expert panel, based on inferences from existing literature and on their own clinical experiences. Indirect cost is estimated based on lost earnings associated with projections of restricted activity days, excess unemployment, and excess mortality. Total lifetime cost in 1990 dollars of all persons with epilepsy onset in 1990 was estimated at $3.0 billion, with indirect cost accounting for 62% of the total. Cost per patient ranged from $4,272 for persons with remission after initial diagnosis and treatment to $138,602 for persons with intractable and frequent seizures. Antiepileptic drug (AED) treatment is the most costly category of service. Different assumptions about the amount and type of drug administration cause major changes in overall cost estimates.

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Population-based hospitalization rates for preventable conditions are derived for a low-income population in Galveston County, Texas using discharge data from four area hospitals and demographic data from the U.S. Census. Comparisons are made with similar rates for the general populations of two eastern states (Maryland and Massachusetts) and New York City. Results support the hypothesis that low-income persons lack access to primary care, leading to higher rates of hospitalization for preventable conditions. Alternative explanations for differences found are examined.

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The initial response and long-term follow-up of 74 evaluable patients who received combination chemotherapy for metastatic nonseminomatous testicular cancer are reported. Patients were treated with a protocol (VAB-3) including vinblastine, actinomycin-D, bleomycin, and cis-dichlorodiammine platinum (DDP). VAB-3 alone caused complete remission (CR) in 54% (40/74) and partial remission (PR) in 26% (1974). Five patients with less than CR to chemotherapy achieved CR following surgical excision of residual mature teratoma after starting VAB-3 protocol, resulting in an overall CR rate of 61% (45/74). With a minimum follow-up of 24+ months, and a median follow-up of 35+ months for those still living, 45% (33/74) of the patients are living free of evidence of disease, 4% (3/74) are living with disease, and 51% (38/74) are dead. Response to VAB-3 protocol was examined with respect to performance status, histology, prior therapy, extent of disease, tumor markers, and duration of disease from diagnosis. No one died because of toxicity of VAB-3, and life-threatening toxicity was uncommon. Long survival is significantly associated (P less than 0.001) with achievement of CR. The treatment goal for metastatic testicular cancer is cure. The achievement of CR, using aggressive combination chemotherapy and surgery, is essential in reaching this goal.

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