A model of the clinical course of epilepsy from onset until remission
or death has been developed for six prognostic groups, including survi
val, use and cost of medical care, and time lost from work and houseke
eping. The model has been used to generate preliminary estimates of th
e lifetime cost of epilepsy for a cohort of persons diagnosed in 1990
in the United States. The distribution of incident cases among prognos
tic groups is derived from epidemiologic studies of prognosis in epile
psy. Direct cost is estimated by multiplying nationally representative
unit costs by the expected type and frequency of medical care use. Th
e latter were derived by an expert panel, based on inferences from exi
sting literature and on their own clinical experiences. Indirect cost
is estimated based on lost earnings associated with projections of res
tricted activity days, excess unemployment, and excess mortality. Tota
l lifetime cost in 1990 dollars of all persons with epilepsy onset in
1990 was estimated at $3.0 billion, with indirect cost accounting for
62% of the total. Cost per patient ranged from $4,272 for persons with
remission after initial diagnosis and treatment to $138,602 for perso
ns with intractable and frequent seizures. Antiepileptic drug (AED) tr
eatment is the most costly category of service. Different assumptions
about the amount and type of drug administration cause major changes i
n overall cost estimates.