Cost evaluations in epilepsy: an update

The purpose of this article is to describe the developments in the methodology of studies of the cost of epilepsy and cost-effectiveness of treatments in light of previous reviews and recently published methodological guidelines. Several recent studies are compared, with recently published guidelines by the US Public Health Service (PHS) serving as a framework for discussing selected methodological issues. Results show that these recent studies have made important gains in the quality of cost data obtained, with advances being made by studies that base cost estimates on actual patient data from representative samples as opposed to secondary sources and expert opinions. However, a wide variety of methods continue to be used for many aspects of study design and reporting. Method heterogeneity remains an obstacle to presenting and interpreting reliable and valid information on costs and cost-effectiveness. Areas in need of additional development are methods for estimating direct nonmedical costs, attributing costs to epilepsy versus comorbid conditions, validating health state valuation methods for this population, and validating current recommendations for capturing the costs of lost productivity due to epilepsy. PHS panel recommendations provide a useful framework for working toward consistency in the methods for economic studies in epilepsy.