عوامل موثر بر هزینه های صرع در بزرگسالان مبتلا به معلولیت ذهنی

Purpose Despite the common occurrence of intellectual disability (ID) in people with epilepsy, most studies of the cost of epilepsy have focussed primarily or exclusively on people without ID. This paper estimates the costs of supporting people with epilepsy and ID. Methods Prospective resource use and outcome data were collected on 91 participants from the east of England for seven months. Multivariate analysis was used to investigate the relationship between costs and patient and healthcare provider characteristics. Results Mean health care costs relating to epilepsy or ID were £2800 (3500 Euros, 5200 USD) p.a. Modelling suggests costs are lower for patients with more severe ID (p = 0.014); and higher for patients managed by a consultant neurologist (p = 0.037). Discussion Our findings support limited evidence from the literature of increased epilepsy costs in people with ID. Patterns of expenditure suggest clinical variation in the treatment of epilepsy according to the severity of ID, particularly in the absence of management by a consultant neurologist.

Epilepsy imposes significant financial costs on individuals, families and the health care services supporting them. As a consequence, an understanding of the costs of epilepsy and the factors influencing those costs is important for the efficient delivery of care for people with epilepsy.1 Whilst a number of studies have examined costs of epilepsy in regions around the world,2, 3, 4, 5 and 6 patients with significant intellectual disability (ID) (defined as an IQ of 70 or less) are often excluded. In addition, psychiatric co-morbidities, which occur at increased rates in those with ID7 and social support costs for people with epilepsy and ID are rarely considered in detail. Nevertheless, ID is relatively common in people with epilepsy, probably occurring in at least 25%.8 and 9 Similarly, epilepsy is common in adults with ID,10 with an overall prevalence of around 26%.11 Epilepsy in adults with ID has a worse prognosis than epilepsy in the general population, with lower rates of seizure freedom,9 high rates of multiple antiepileptic drug use,12 and high rates of comorbidity13 and mortality.14 All these factors are likely to have important financial implications. Hence adults with ID represent a distinct and sizeable proportion of those with epilepsy and one for which costs associated with delivery of epilepsy care remains under-researched. Our aim in this paper is to report the health and social care costs of supporting adults with active epilepsy and ID living in the community in the UK and to explore determinants of those costs.

Costs on health and social services of supporting people with epilepsy and ID are high, primarily due to the cost of providing appropriate accommodation and living support along with appropriate activities for people with ID. Epilepsy related health care costs are a small fraction of overall costs. However, this study suggests that the costs of epilepsy management are higher for people with ID than for the rest of the population. Whilst affective and neurological comorbidities are relatively common in this clinical group, they were not found to contribute to differences in cost estimates for epilepsy related care. The results of the study do suggest that a significant determinant of epilepsy health care utilisation, as reflected in financial costs accrued, is a perception by carers of a worse health state in the person they are caring for. The unexpected finding of relatively lower epilepsy related costs in those with severe and profound ID could relate to less intensive epilepsy management in these groups, and this together with the apparent differential financial consequences of receiving treatment from neurology as opposed to ID or primary care services requires further investigation.