Economic Differences in Direct and Indirect Costs Between People With Epilepsy and Without Epilepsy

*Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences †Department of Clinical Pharmacy, University of Colorado, Aurora, CO ‡Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA.
Medical care (Impact Factor: 3.23). 11/2012; 50(11):928-33. DOI: 10.1097/MLR.0b013e31826c8613
Source: PubMed


: To provide generalizable estimates of economic burden in epilepsy and nonepilepsy populations and a comprehensive accounting for employment-based lost productivity associated with epilepsy in current US health care systems as compared with other chronic diseases.
: We use the nationally representative data source (Medical Expenditure Panel Survey) from 1998 to 2009 to create a retrospective cohort of people diagnosed with epilepsy by a health professional and a comparison cohort of people with no epilepsy.
: Health care utilization and direct costs for all components of treatment, including prescription medications, wages, employment, educational attainment, family income, and lost productivity were outcomes.
: We observed economic disparities associated with epilepsy in the United States despite high rates of modern treatments (89% on anticonvulsant therapies). Only 42% of the people with epilepsy over age 18 reported employment compared with 70% of people with no epilepsy; among those, people with epilepsy reported missing an average of 12 days of work because of illness or injury as compared with 4 days in the nonepilepsy cohort. Holding other variables constant, people with epilepsy had a loss of productivity of $9504 in 2011 dollars compared with people with no epilepsy. In comparison, diabetes was associated with annual average lost productivity valued at $3358 and depression at $3182.
: Lost wage-based productivity associated with epilepsy was nearly equal to combined wage losses associated with diabetes, depression, anxiety, and asthma together. To evaluate societal burden of illness, results illustrate the importance of indirect costs in addition to treated prevalence and direct medical costs.

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    • "[2] [3]. Unemployment and early disability are the two main factors for high indirect costs because of epilepsy [4], with indirect costs having been shown to exceed the direct costs [5] [6]. In contrast to factors contributing to unemployment [7] [8], factors associated with EPD in patients with epilepsy are largely unknown. "
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    ABSTRACT: The purpose of this study was to assess the risk factors for early disability pension (EDP) in adult patients with epilepsy in a specialized epilepsy rehabilitation setting. In a retrospective study, 246 patients with epilepsy and employment difficulties leading to referral to an inpatient rehabilitation unit were evaluated with a questionnaire on admission and after a mean of 2.5years after discharge. Patients already receiving EDP at baseline were excluded. Epilepsy-related, demographic, and employment-related data as well as cognitive functioning and psychiatric comorbidity were assessed as risk factors for EDP at follow-up and analyzed using logistic regression models. Seventy-six percent of the patients had uncontrolled epilepsy, and 66.7% had psychiatric comorbidity. At follow-up, 33.7% received an EDP. According to multivariate logistic regression analysis, age>50years (odds ratio (OR) 5.44, compared to age<30years), application for an EDP prior to admission (OR 3.7), sickness absence>3months in the previous year (OR 3.30, compared to sickness absence<3months), and psychiatric comorbidity (OR 2.79) were significant risk factors for an EDP at follow-up, while epilepsy-related factors and cognitive impairment showed an effect only in the univariate analyses. Potential risk factors for EDP in patients with epilepsy were evaluated using multivariate analysis. Knowledge of such factors may help to develop appropriate criteria for rehabilitation candidacy and interventions to reduce the risk for EDP. This might lead to an amelioration of both psychosocial burden of patients and economic burden on society. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Aug 2015 · Epilepsy & Behavior
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    • "We needed to use child abuse incidence rates as the basis for our calculation as previous studies have done (Libby et al., 2012), but there are no official data in Japan on the incidence of abuse. Therefore, using the same estimation method as Ae, Nakamura, Tsuboi, Kojo, and Yoshida (2012), the present study estimated percentages of child abuse experience by gender and age group (ages 20–64). "
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    ABSTRACT: The present study calculates the social costs of child abuse in Japan. The items calculated included the direct costs of dealing with abuse and the indirect costs related to long-term damage from abuse during the fiscal year 2012 (April 1, 2012, to March 31, 2013). Based on previous studies on the social costs of child abuse and peripheral matters conducted in other countries, the present study created items for the estimable direct costs and indirect costs of child abuse, and calculated the cost of each item. Among indirect costs, future losses owing to child abuse were calculated using extra costs with a discount rate of 3%. The social cost of child abuse in Japan in the fiscal year 2012 was at least \1.6 trillion ($16 billion). The direct costs totaled \99 billion ($1 billion), and the indirect costs totaled \1.5 trillion ($15 billion). This sum of \1.6 trillion for only the year 2012 is almost equal to the total amount of damages of \1.9 trillion caused by the 2011 Tohoku Earthquake and Tsunami in Fukushima Prefecture. Moreover, abuse is a serious problem that occurs every year and has recurring costs, unlike a natural calamity. However, Japan has no system for calculating the long-term effects of abuse. Therefore, owing to the scarcity of data, the calculations in the present study may underestimate the true costs.
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