Charles E. Begley

Standards for epidemiologic studies and surveillance of epilepsy

Worldwide, about 65 million people are estimated to have epilepsy. Epidemiologic studies are necessary to define the full public health burden of epilepsy; to set public health and health care priorities; to provide information needed for prevention, early detection, and treatment; to identify education and service needs; and to promote effective health care and support programs for people with epilepsy. However, different definitions and epidemiologic methods complicate the tasks of these studies and their interpretations and comparisons. The purpose of this document is to promote consistency in definitions and methods in an effort to enhance future population‐based epidemiologic studies, facilitate comparison between populations, and encourage the collection of data useful for the promotion of public health. We discuss: (1) conceptual and operational definitions of epilepsy, (2) data resources and recommended data elements, and (3) methods and analyses appropriate for epidemiologic studies or the surveillance of epilepsy. Variations in these are considered, taking into account differing resource availability and needs among countries and differing purposes among studies.

The cost of epilepsy in the United States: an estimate from population-based clinical and survey data.

Summary: 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.

The Lifetime Cost of Bipolar Disorder in the US: An Estimate for New Cases in 1998

AbstractObjective: To develop a cost model that estimates the total and per case lifetime cost of bipolar disorder for 1998 incident cases in the US. Study design: Lifetime cost simulation model. Perspective: Societal. Methods: Age- and gender-specific incidence of bipolar disorder in 1998 was estimated by simulation based on existing prevalence data. The course of illness and mental health service cost of 6 clinically defined prognostic groups was estimated based on the research literature and the judgement of panels of experts. Excess cost of general medical care was estimated based on claims data from a large insurer. Indirect cost was projected including excess unemployment and reduced earnings reported in the National Comorbidity Survey. Comorbidity treatment and indirect cost related to alcohol (ethanol) and drug abuse was added based on a National Institute on Drug Abuse study. Results: The present value of the lifetime cost of persons with onset of bipolar disorder in 1998 was estimated at 24 billion US dollars (

Cost of Epilepsy in the United States: A Model Based on Incidence and Prognosis

US). Average cost per case ranged from

The Economic Cost of Epilepsy: A Review of the Literature

US11 720 for personswith a single manic episode to

Disparities in epilepsy: Report of a systematic review by the North American Commission of the International League Against Epilepsy

US624 785 for persons with nonresponsive/chronic episodes. Conclusion: The model indicates the potential cost savings of preventing a case of bipolar disorder and underscores the importance of achieving a stable outcome in new cases to limit the economic consequences of the disorder.

Emergency Department Diversion and Trauma Mortality: Evidence From Houston, Texas

Summary: 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

Sociodemographic disparities in epilepsy care: Results from the Houston/New York City health care use and outcomes study

3.0 billion, with indirect cost accounting for 62% of the total. Cost per patient ranged from

Methodological issues in estimating the cost of epilepsy.

4,272 for persons with remission after initial diagnosis and treatment to

Emergency Room Use and Access to Primary Care: Evidence from Houston, Texas

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.