Cost-of-illness of epilepsy in Italy - Data from a multicentre observational study (Episcreen)

Objective: To investigate the impact of epilepsy in Italy on healthcare res ources, producing an average cost per patient per year of follow-up. Design and setting: The Episcreen Project is a multicentre longitudinal Ita lian observational study; its methodology, organisational network and case report form have been reported in detail elsewhere. Using a subset of patie nts with epilepsy from this project, we conducted a retrospective cost-of-i llness analysis based on clinical records. The analysis was performed from the societal (community) perspective, including both direct and indirect co sts. Hospital admissions, day-hospital visits, specialist visits, instrumental e xaminations, drugs and productivity losses because of visits and hospitalis ation were analysed. Each cost variable was valued in 1996 Italian liras (L ) using published national tariffs (except for drugs for which published pr ices were used). A sensitivity analysis was conducted on indirect costs to test the robustness of the assumption that 1 working day lost for each day hospital visit would produce a change of 0.3% in the weight of indirect cos ts. Patients and participants: Patients analysed in this study were registered in the Episcreen database as at 21 November 1996. They were diagnosed with epilepsy at the last visit, had at least 1 follow-up visit (i.e. at least 1 visit after the enrolment visit), and had at least 12 months of follow-up. Results: The average cost per patient per year was L2 726 116 ($US1767). Th e average cost per patient was higher for children than for adults [L3 629 997 ($US2353) and L2 362 134 ($US1531), respectively), and for newly diagno sed patients for whom the first diagnosis of epilepsy was addressed at the first Episcreen visit [adults: old referrals L1 304 353 ($US845), new refer rals L6 901 374 ($US4473); children: old referrals L2 810 504 ($US1822), ne w referrals L7 814 400 ($US5065)1. Direct costs represented 87.6% of total costs. The major cost driver was ho spitalisation (63.7%), followed by drugs (10.5%), day-hospital visits (4.1% ), outpatient visits (3.85%), other tests (3.1%) and electroencephalographs (2.3%). Indirect costs (lost productivity) represented 12.4% of total cost s. Sensitivity analysis showed that the results are sensitive to the value attributed to lost productivity. Conclusions: The cost of managing a patient with epilepsy in Italy is influ enced by age, syndrome and modality of referral to the centre fur epilepsy.