A Comparison of Two Methods for Estimating the Health Care Costs of Epilepsy

Abstract

Summary:Purpose: Previous studies have estimated medical care costs of epilepsy by applying unit costs to estimated utilization or by summing costs for (a) ambulatory care and hospitalizations coded as epilepsy and (b) procedures and drugs specifically associated with the diagnosis or treatment of epilepsy. These methods may underestimate the cost of medical care for epilepsy. Two methods for estimating the medical care costs of epilepsy ("epilepsy-attributable cost method" and "case-control cost method") were compared.Methods: The study population was 655 individuals with an epilepsy diagnosis enrolled in a managed care plan in the southwestern United States. The epilepsy-attributable costs were determined by summing costs for inpatient and outpatient encounters coded as epilepsy, procedures for the diagnosis or treatment of epilepsy, and drugs used to treat epilepsy. The case-control method determined costs by calculating the difference in total costs between cases and 1,965 age-and gendermatched controls.Results: The case-control epilepsy costs were $2,923 per case compared with epilepsy-attributable costs of $1,335 per case. The case-control method found statistically significant differences in costs between cases and controls for inpatient care, prescription drugs, and 8 of 11 categories of outpatient care. The largest contributors to the discrepancy between estimates were inpatient care, emergency department care, laboratory tests, and "other specialist" care.Conclusions: Epilepsy-attributable costs accounted for only 46% of the total difference in costs between epilepsy cases and controls. Persons with epilepsy use more medical services than controls, but a substantial portion of this care is not coded to epilepsy.

Health plan paid cost of epilepsy in 2009 in the U.S.

“…Frost et al [14] also reported that inpatient and outpatient costs were the top two cost drivers of epilepsy treatment. In this study, MD office cost accounted for only 14% of total costs for the epilepsy group.…”

“…However, our cost of disease estimate does not include indirect costs of epilepsy. The matched pair control methodology estimates the cost of disease as the additional cost for the diseased group relative to the average cost for the non-diseased population [14]. This analytical approach assumed that the health care cost for the epilepsy patients and the match-pair control group (non-diseased group) would be similar in the absence of epilepsy.…”

“…Frost et al [14] estimated the annual cost of epilepsy treatment using a case-control cost method as $2923 in a relatively healthy managed care population. Begley et al [5] reported that the direct medical cost per member per year (PMPY) was $4559 for patients with active epilepsy, and these costs decreased with time.…”

Economic impact of generic substitution of lamotrigine: projected costs in the US using findings in a Canadian setting

“…This difficulty was reported by Frost et al 36 , who found that considering only the costs of epilepsy drugs, ambulatory care and hospitalizations specifically coded with an epilepsy diagnosis severely understated the overall costs associated with providing medical care to patients with epilepsy. As many cost 'Lowest' and 'highest' are estimates of the cost differences obtained using, respectively, the lowest and highest values of the cost conversion parameters observed during the study period (see Table 2).…”

Case-Control Studies in Pharmacoeconomic Research

“…[25,26] The method is not confined to human studies. [27] Recently, many pharmacoeconomic studies have appeared also claiming to use the case-control approachthis time to address the costs of illnesses, [28][29][30][31][32][33][34][35][36][37] their impact on quality of life (QOL) [38,39] and other aspects of importance in this young field. [40][41][42] Given the power and efficiency of the casecontrol method and its extensive theoretical, technical and practical development, it is heartening to see its application to our field.…”