March 30, 2000 (Atlanta) -- As many as 44% of the people in the U.S. who have epilepsy -- more than 1 million people -- continue to have seizures, despite getting medical treatment, according to a report in the March issue of the journal Epilepsia.
These people, and others who have uncontrolled epilepsy, contribute disproportionately to the cost of treating the chronic disease, say researchers who found that patients with poor seizure control represented 25% of all cases, but accounted for up to 86% of all costs.
Patients with uncontrolled epilepsy racked up nearly $10,000 a year in direct medical costs, while patients with controlled cases had a tab of only about $2,000 a year. Study author Charles Begley, PhD, a health economist and associate professor of public health at the University of Texas in Austin, says controlling seizures may help reduce costs.
The annual cost of the estimated 2.3 million cases was projected to be $12.5 billion, with antiepilepsy drugs accounting for 30% of direct medical costs. Indirect costs, such as lost earnings and lost productivity, accounted for 85% of total costs and were significantly higher than 1975 estimates suggested, researchers say. The cost of diagnosis and treatment is likely to increase as the U.S. population ages.
Begley says most of the costs are incurred up front. "The data showed that high costs were incurred for diagnostic evaluation and initial treatment," he says. "But over three years, a downward trend reflected a large number of patients that achieved remission." Begley tells WebMD that older adults account for a large portion of direct medical costs.
"Older people had low indirect costs due to a shorter life expectancy and lower earnings," says Begley. "But older adults received more antiepilepsy drugs and were hospitalized more often. Given the increasing numbers of older Americans, direct care costs for the elderly are a major concern."
To evaluate the current economic impact, researchers calculated the direct costs of diagnosis and treatment from the medical bills of more than 600 new cases. The indirect costs of lost earnings and productivity were calculated from a survey of more than 1,200 patients in regional treatment centers. By applying U.S. population figures, the annual cost of epilepsy was estimated.
"The high concentration of costs in patients with [difficult to manage] epilepsy emphasizes the importance of seizure control," says Begley. "And some new medical and surgical interventions hold a lot of promise." Begley tells WebMD that new treatments may increase direct costs but are likely to decrease indirect costs, and other doctors agree.
"We've got about a dozen antiepilepsy drugs, but some patients don't respond to them," says Charles Epstein, MD, an epilepsy specialist and an associate professor of neurology at Emory University in Atlanta. "And HMOs understand the value of good symptom control. So if drug therapy fails, we use electrical stimulation of the vagus nerve." Epstein says surgery is another alternative for patients with poor seizure control.
"If nerve stimulation fails, a small portion of the brain can be removed," says Epstein. "But surgery is expensive and complicated, so digital technology is the new paradigm for [difficult to treat] epilepsy." Epstein tells WebMD that implants will soon sense seizure activity and deliver antiepilepsy drugs.
"Implanted computer chips will detect seizures and inject medication in the affected area," says Epstein. "It's all technically feasible but won't be available for a few years."
Epstein, who reviewed the study for WebMD, says some costs weren't captured in the analysis, and the researchers agree.
"Special education, child care, and transportation costs were not reflected in the estimates," says Begley. "And a study period of only six years could affect long-term projections. Still, the results represent a reasonable update." Begley tells WebMD that a follow-up study of uncontrolled epilepsy is already underway.
The study was supported with a three-year grant from the Epilepsy Foundation and Aventis Pharmaceuticals, formerly Hoechst Marion Roussel.
- The annual cost of epilepsy in this country is estimated to be $12.5 billion, according to a new study.
- Patients with poor seizure control represent a disproportionate amount of the costs of the disease.
- Treatments for epilepsy include medications (which some patients don't respond to), electrical stimulation of the vagus nerve, or surgical removal of a small portion of the brain.