Burden of uncontrolled epilepsy in patients requiring an emergency room visit or hospitalization

Ancona, Italy.
Neurology (Impact Factor: 8.29). 06/2013; 80(23):2170. DOI: 10.1212/01.wnl.0000431418.01737.3f
Source: PubMed


Manjunath et al.(1) performed a cost analysis related to patients with epilepsy and found that those with uncontrolled epilepsy who required an emergency department (ED) visit or hospitalization posed clinical and economic burdens to health care providers and to society. We conducted a prospective study to analyze the burden of epilepsy at a regional hospital. In an attempt to develop a hypothetical prediction model, we evaluated factors associated with ED access by patients with an already-known diagnosis of epilepsy after a new seizure episode. In our analysis, we focused on direct health care costs by constructing a logistic model to predict ED visit. Factors related to ED visit were nationality, current psychiatric therapy, current antiepileptic drug polytherapy, comorbidities, recurrent same-day epileptic seizures, and seizure characteristics. A care model-based on knowledge of these predictive factors-could help to reduce the economic burden of uncontrolled epilepsy. In an era of increasing health care costs and shrinking resources, economic studies applied to health services are vital to increasing the awareness of how epilepsy affects individuals and society.(2.)

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Available from: Simona Balestrini, Aug 28, 2014
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    ABSTRACT: Background In the UK, epilepsy is the neurological condition with the highest rate of accident and emergency department re-attendance, with most arriving by ambulance. Ambulance clinicians triage patients and assess their need for attendance. This study examined the decision-making process of ambulance clinicians in these situations. Methods In-depth interviews with 15 ambulance clinicians working in South London. Results Interviewees identified that epileptic seizures that self-resolve present a triage challenge. They reported insufficient training and guidance available for these situations and substantial reliance on experience to direct their practice. Fears of litigation in the event of complications, pressures of public expectation and limited on-scene access to relevant patient information or appropriate alternative care pathways were reported to be significant factors influencing decisions for care for epilepsy seizures. Discussion Ambulance clinicians reported negotiating a balance between patient safety and patient choice, when deciding whether to transport a patient with epilepsy to hospital or not. Clinician fears and the pressures and limitations of practice may result in hospital conveyance being used as a safety precaution in some instances. Conclusions Decisions regarding conveyance of patients with epilepsy in this study were substantially guided by ambulance clinician experience rather than by robust training and guidelines. This study supports the need for improved guidance that addresses this common area of practice and the development of alternative care pathways that may be used by ambulance clinicians for patients with epilepsy.
    Emergency Medicine Journal 03/2012; 30(3). DOI:10.1136/emermed-2011-200388 · 1.84 Impact Factor
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    ABSTRACT: Based on available epidemiologic, health economic, and international population statistics literature, the cost of epilepsy in Europe was estimated. Europe was defined as the 25 European Union member countries, Iceland, Norway, and Switzerland. Guidelines for epidemiological studies on epilepsy were used for a case definition. A bottom-up prevalence-based cost-of-illness approach, the societal perspective for including the cost items, and the human capital approach as valuation principle for indirect costs were used. The cost estimates were based on selected studies with common methodology and valuation principles. The estimated prevalence of epilepsy in Europe in 2004 was 4.3-7.8 per 1,000. The estimated total cost of the disease in Europe was euro15.5 billion in 2004, indirect cost being the single most dominant cost category (euro8.6 billion). Direct health care costs were euro2.8 billion, outpatient care comprising the largest part (euro1.3 billion). Direct nonmedical cost was euro4.2 billion. That of antiepileptic drugs was euro400 million. The total cost per case was euro2,000-11,500 and the estimated cost per European inhabitant was euro33. Epilepsy is a relevant socioeconomic burden at individual, family, health services, and societal level in Europe. The greater proportion of such burden is outside the formal health care sector, antiepileptic drugs representing a smaller proportion. Lack of economic data from several European countries and other methodological limitations make this report an initial estimate of the cost of epilepsy in Europe. Prospective incidence cost-of-illness studies from well-defined populations and common methodology are encouraged.
    Epilepsia 01/2008; 48(12):2224-33. DOI:10.1111/j.1528-1167.2007.01251.x · 4.57 Impact Factor
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