EPILEPSY COST OF ILLNESS IN THE US PRIVATELY INSURED [P05.083]

Howard G. Birnbaum, Boston, MA; Jasmina I. Ivanova, New York, NY; Yohanne Kidolezi, Boston, MA; Ying Qiu, Whitehouse Station, NJ; Sue Caleo, Beerse, Belgium

Epilepsy is a chronic, often severely disabling condition that affects an estimated 2.5 million people in the United States.¹ Many patients with epilepsy require the prolonged use of complex drug regimens, as well as a range of other medical services (eg, emergency department visits, visits with neurologists of other specialists, or surgery), resulting in substantial epilepsy-related healthcare costs for patients and for society as a whole.²

In this poster, Birnbaum et al examined the direct costs of epilepsy treatment from insurers to providers among privately insured patients in the United States. Administrative claims data were obtained for more than 6 million beneficiaries from 31 self-insured large companies over the 7-year period from 1999 to 2005. Adult patients with epilepsy were included in the study provided that they had at least 24 months of continuous insurance coverage and that they were not eligible for Medicare. The same criteria were used to construct a control group of adults without epilepsy who were matched to the patients by age, sex, region, and employment status. The final study population consisted of 4323 patients with epilepsy and 4323 matched control subjects. Resource use and treatment costs were examined for all subjects during the year 2005.

Patients with epilepsy had significantly higher rates of several comorbid medical conditions than matched control subjects (all P values <.0001), including migraine headache (8.2% vs 2.3% for epilepsy and control groups, respectively), cerebrovascular disease (8.4% vs 0.8%), diabetes (7.4% vs 5.7%), malignancy (4.5% vs 2.2%), and psychiatric disorders (28.8% vs 12.7%). Patients with epilepsy also had significantly higher rates of medical resources used during the 12-month study period (all P values <.0001), including inpatient visits (16.4% of patients vs 7.1% of controls), emergency department visits (30.4% vs 19.1%), and outpatient visits (including diagnostic visits, visits to neurologists and psychiatrists, primary care visits, and clinic visits).

The total medical costs for patients with epilepsy averaged $10 258 per year, compared with mean annual costs of $3862 for matched control subjects. The patients had significantly greater mean annual costs than matched control subjects for medications ($2815 vs $824), inpatient visits ($2915 vs $886), emergency department visits ($309 vs $126), and outpatient or other visits ($4219 vs $2026). Although the mean annual treatment cost for patients with epilepsy exceeded the mean cost of the control group by more than $6000, the mean cost of care that was specifically related to the treatment of epilepsy was only $2057 per year, or approximately 20% of all direct healthcare costs for these patients. Thus, most of the increased healthcare cost was actually attributable to the treatment of comorbid conditions.

This analysis evaluated only direct medical costs from insurers to providers—in previous studies, indirect costs due to lost earnings and reductions in household activities have been estimated to far exceed the direct costs of epilepsy treatment.³

References
1. Centers for Disease Control and Prevention. National epilepsy awareness month. Available at: http://www.cdc.gov/Features/EpilepsyAwareness/. Accessed May 30, 2009.
2. Frost FJ, Hurley JS, Petersen HV, et al. A comparison of two methods for estimating the health care costs of epilepsy. Epilepsia. 2000;41:1020-1026.
3. Begley CE, Famulari M, Annegers JF, et al. The cost of epilepsy in the United States: an estimate from population-based clinical and survey data. Epilepsia. 2000;41:342-351.