Methodological issues in estimating the cost of epilepsy

Changes in treatment alternatives and the emphasis on cost containment and managed care have increased the interest in information on the cost of epil epsy. The last comprehensive cost study in the USA was in 1975. That study estimated the national cost of epilepsy at $3.6 billion for 2.1 million cas es. On a per patient basis the 1975 figure represents $7440 in 1995 US doll ars, $1150 (15%) for direct treatment-related costs and $6290 (85%) for ind irect employment-related costs. Since then, various cost-of-illness (COI) s tudies in the USA and other countries have offered estimates ranging from $ 6000 to $15000 per patient per year, with percentages of direct and indirec t cost varying greatly. To assist those interested in interpreting or produ cing cost information, this paper reviews the state of research on the cost of epilepsy and discusses several methodological issues. A comprehensive s tudy begun in 1993 to update the 1975 estimates for the USA is also describ ed. Recommendations are provided to stimulate discussion about the best met hods to use in future research. (C) 1999 Elsevier Science B.V. All rights r eserved.