ABSTRACT
BACKGROUND AND PURPOSE: Disease burden of epilepsy in Hungary is underexplored. The aim of our study was to assess the quality of life and costs of adults with epilepsy. METHODS: Cross-sectional questionnaire survey was performed in two hospital based outpatient neurology centres involving consecutive patients with epilepsy. Demography, clinical characteristics, health status (EQ-5D) and health care utilisation in the past 12 months were surveyed. Cost calculation was performed from the societal perspective. RESULTS: Altogether 100 patients (women 58%) were involved, their mean age was 37.6 (SD = 12.5) years. Disease duration was 15.0 (SD = 12.1) years on average and 22 (22%) patients were disability pensioners. The EQ-5D score was mean 0.83 (SD = 0.24) which is significantly lower than the age-matched population norm (p = 0.017). Pain/discomfort and anxiety/depression are the most problematic health dimensions. The annual cost per patient was mean 2421 (SD = 3249) Euros (679 397 SD = 911 783 HUF; conversion: 1 Euro = 280.6 HUF), distribution between direct medical, direct non-medical and indirect costs was 33%, 18% or 49%. Patients with seizure in the past 12 months have higher cost on avergare than the asymptomatic subsample (3119 vs. 988 Euros/patient/year; 935 481 vs. 277 209 HUF/patient/year). CONCLUSION: Adults with epilepsy have significantly worse health status by the EQ-5D than the gender and age matched Hungarian general population. Disease related costs are significant especially in cases with seizure, productivity loss related costs are dominant. Our study provides basic data for clinical and sustainable health care financing decisions.
Subject(s)
Cost of Illness , Disabled Persons , Epilepsy/economics , Epilepsy/epidemiology , Health Care Costs/statistics & numerical data , Quality of Life , Adult , Aged , Anxiety/etiology , Cross-Sectional Studies , Depression/etiology , Disabled Persons/psychology , Disabled Persons/statistics & numerical data , Efficiency , Epilepsy/complications , Epilepsy/psychology , Female , Health Status , Humans , Hungary/epidemiology , Male , Middle Aged , Pain/etiology , Pensions , Seizures/economics , Severity of Illness Index , Surveys and QuestionnairesSubject(s)
Chromosome Deletion , Chromosomes, Human, Pair 17/genetics , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Mutation , Practice Guidelines as Topic , Pyrazoles/therapeutic use , Pyrimidines/therapeutic use , Tumor Suppressor Protein p53/genetics , Adenine/analogs & derivatives , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/genetics , PiperidinesABSTRACT
Currently, the 13-valent pneumococcal conjugate vaccine (PCV13) is administered under a 1+1 (1 primary dose) pediatric schedule in the United Kingdom (UK). Higher-valency PCVs, 15-valent PCV (PCV15), or 20-valent PCV (PCV20) might be considered to expand serotype coverage. We evaluated the cost-effectiveness of PCV20 or PCV15 using either a 2+1 (2 primary doses) or 1+1 schedule for pediatric immunization in the UK. Using a dynamic transmission model, we simulated future disease incidence and costs under PCV13 1+1, PCV20 2+1, PCV20 1+1, PCV15 2+1, and PCV15 1+1 schedules from the UK National Health Service perspective. We prospectively estimated disease cases, direct costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Scenario analyses were performed to estimate the impact of model assumptions and parameter uncertainty. Over a five-year period, PCV20 2+1 averted the most disease cases and gained the most additional QALYs. PCV20 2+1 and 1+1 were dominant (cost-saving and more QALYs gained) compared with PCV15 (2+1 or 1+1) and PCV13 1+1. PCV20 2+1 was cost-effective (GBP 8110/QALY) compared with PCV20 1+1. PCV20 was found cost-saving compared with PCV13 1+1, and PCV20 2+1 was cost-effective compared with PCV20 1+1. Policymakers should consider the reduction in disease cases with PCV20, which may offset vaccination costs.