Demographics and cost of epilepsy. Based on a presentation by John F. Annegers, PhD

Over the past decade, there has been considerable interest in cost-of-illness studies for many diseases, including epilepsy. However, the nature of epilepsy and the wide spectrum of its clinical course make it difficult to assess the overall costs of the disease. Differences in incidence rates by age, gender, etiology, and other demographic variables further complicate the task of assessing costs. The incidence is highest in the first decade of life and in the elderly. A cost-simulation study based on incidence and prognosis sheds light on how costs are estimated. This type of study also serves as a prelude to cost-of-disease studies, cost-benefit studies, and cost-effectiveness studies. Approximately 70% of patients with new-onset epilepsy will achieve remission relatively quickly and at relatively low cost. The picture is far less rosy for patients with intractable seizures; for them, the outcome is fair to poor, and the lifetime costs are high. An empiric version of the cost-stimulation study is now under way. Its objectives are to identify incidence cases of epilepsy in two cohorts, collect longitudinal data on each case, estimate the costs of care over time and across service, measure patterns of resource use over time, and use the resultant direct cost estimates as a national cost model.