Prevalence of Treated Epilepsy in Korea Based on National Health Insurance Data

The Korean national health security system covers the entire population and all medical facilities. We aimed to estimate epilepsy prevalence, anticonvulsant utilization pattern and the cost. We identified prevalent epilepsy patients by the prescription of anticonvulsants under the diagnostic codes suggesting seizure or epilepsy from 2007 Korean National Health Insurance databases. The information of demography, residential area, the kind of medical security service reflecting economic status, anticonvulsants, and the costs was extracted. The overall prevalence of treated epilepsy patients was 2.41/1,000, and higher for men than women. The age-specific prevalence was the lowest in those in their thirties and forties. Epilepsy was more prevalent among lower-income individuals receiving medical aid. The regional prevalence was the highest in Jeju Island and lowest in Ulsan city. New anticonvulsants were more frequently used than old anticonvulsants in the younger age group. The total annual cost of epilepsy or seizure reached 0.46% of total medical expenditure and 0.27% of total expenditure on health. This is the first nationwide epidemiological report issued on epilepsy in Korea. Epilepsy prevalence in Korea is comparable to those in developed countries. Economic status and geography affect the prevalence of epilepsy.

Measuring medicine prices in Peru: validation of key aspects of WHO/HAI survey methodology / Determinación de los precios de los medicamentos en Perú: validación de aspectos fundamentales del método de encuesta de la OMS/HAI

Objectives: To assess the possibility of bias due to the limited target list and geographic sampling of the World Health Organization (WHO)/Health Action International (HAI) Medicine Prices and Availability survey used in more than 70 rapid sample surveys since 2001. Methods: A survey was conducted in Peru in 2005 using an expanded sample of medicine outlets, including remote areas. Comprehensive data were gathered on medicines in three therapeutic classes to assess the adequacy of WHO/HAI's target medicines list and the focus on only two product versions. WHO/HAI median retail prices were compared with average wholesale prices from global pharmaceutical sales data supplier IMS Health. Results: No significant differences were found in overall availability or prices of target list medicines by retail location. The comprehensive survey of angiotensin-converting enzyme inhibitor, anti-diabetic, and anti-ulcer products revealed that some treatments not on the target list were costlier for patients and more likely to be unavailable, particularly in remote areas. WHO/HAI retail prices and IMS wholesale prices were strongly correlated for higher priced products, and weakly correlated for lower priced products (which had higher estimated retailer markups). Conclusions: The WHO/HAI survey approach strikes an appropriate balance between modest research costs and optimal information for policy. Focusing on commonly used medicines yields sufficient and valid results. Surveyors elsewhere should consider the limits of the survey data as well as any local circumstances, such as scarcity, that may call for extra field efforts.

Objetivos: Evaluar la posibilidad de sesgo debido a la limitación de la lista de referencia y del muestreo geográfico de la encuesta de precios y disponibilidad de medicamentos de la Organización Mundial de la Salud/Health Action International (OMS/HAI) usada en más de 70 muestras de encuestas rápidas desde el 2001. Métodos: En el año 2005, se realizó una encuesta en Perú, con una muestra ampliada de puntos de venta de medicamento, incluso en zonas remotas. Se recogieron datos integrales acerca de los medicamentos de tres clases terapéuticas, con el fin de evaluar la idoneidad de la lista de referencia de medicamentos de la OMS/HAI y el énfasis únicamente en dos versiones del producto. Las medianas de los precios al por menor de la OMS/HAI se compararon con el promedio de precios al por mayor del proveedor de datos mundiales de ventas farmacéuticas IMS Health. Resultados: No se observó ninguna diferencia significativa en la disponibilidad general ni en los precios de los medicamentos de la lista de referencia por localización de venta al por menor. La encuesta integral de los inhibidores de la enzima convertidora de la angiotensina, los antidiabéticos y los productos antiulcerosos reveló que algunos tratamientos que no están en la lista destinataria eran más caros para los pacientes y era más probable que no estuvieran a la venta, sobre todo en las regiones remotas. Los precios al por menor de la OMS/HAI y los precios al por mayor de IMS presentaron una correlación intensa en el caso de los productos de precio más alto, y la correlación fue débil en el caso de los productos de precio más bajo (que tuvieron márgenes de beneficio calculados más altos para el minorista). Conclusiones: El método de la encuesta de la OMS/HAI logra un equilibrio adecuado entre los costos de investigación moderados y la información óptima para la política. El énfasis en los medicamentos de uso frecuente produce unos resultados válidos y suficientes. Los encuestadores de otros...

Costo médico directo de la epilepsia en la población hospitalaria del Hospital III Miguel Grau de EsSalud / Direct medical costs of epilepsy in Hospital III Miguel Grau of EsSalud (Peruvian Social Security)

Objetivo: Evaluar los costos directos de la epilepsia de una población hospitalaria de la Seguridad Social, durante el 2006. Señalar qué grupo de pacientes epilépticos tienen más costos directos. Metodología: Se realizó un estudio retrospectivo en 462 pacientes con epilepsia, para estimar los costos médicos directos, se consideraron el Valor de venta = Precio de venta - 19% IGV (impuesto general a la venta), obtenidos del tarifario de Essalud, y los precios de los fármacos antiepilepticos (FAE) todos genéricos, que son los más bajos del mercado nacional. El análisis estadístico fue de tipo descriptivo y analítico utilizando las pruebas de Chi cuadrado y de t Student. Resultado: El 53,5% fueron varones, con un promedio de: 40,7 años (DS +/- 22,03), el 95,7% de las crisis fueron generalizadas, el 17,7% fueron refractarias, el promedio de consultas fue: 6,26 (DS +/- 3,16), el 9,1% estuvieron hospitalizados, el promedio de hospitalización fue: 6,93 días (DS +/- 4,72). El costo directo anual fue: 71,433.24 USD, el costo directo promedio de la epilepsia controlada fue de: 118,5 USD y de la refractaria de: 321,9 USD (p < 0,0001). Conclusión: Los costos de consulta especializada (37%) y FAE (34%) representaron los mayores costos anuales, el costo directo promedio fue de: 154,61 USD/paciente/año el costo promedio de la epilepsia refractaria fue tres veces mayor que la epilepsia controlada, los costos directos del presente estudio son muy inferiores a los países desarrollados y regionales.

Objectives: To determine direct costs of epilepsy in a population assigned to one hospital in Peruvian Social Security (EsSalud) during year 2006. To point out which group of epileptic patients generate more direct costs. Methodology: A retrospective study including 462 epilepsy patients was performed in order to estimate medical direct costs, considering the Sales Value = Retail price - 19% (Peruvian added value tax), obtained from the EsSalud rate lists; as well as prices for antiepileptic drugs (AED) (generics), which are the lowest within Peru. Descriptive and analytic statistics were used, as well as Chi square and Student's t tests. Results: Fifty three per cent patients were male, and their average age was 40.7 years (+/- 22.03 SD); 95.7% of epileptic episodes were generalized crises, 17.7% were refractory, the average number of hospital visits was 6.26 (+/- 3.16 SD), 9.1% patients were hospitalized, and the average hospital stay was 6.93 days (+/- 4.72 SD). Annual direct costs were 71,433.24 US Dollars, average direct costs for controlled epilepsy were USD 118.5 and for refractory epilepsy, the amount was 321.9 USD (p < 0.0001). Conclusion: Costs for specialized consultations (37%) and AEDs (34%) represented the greatest annual expenses, and the direct average cost was 154.61 USD/patient/year. Average costs for refractory epilepsy were three times higher than those for controlled epilepsy; and direct costs reported in this study are quite lower than those reported in industrialized countries and even in neighboring countries.

Papel de los fármacos antiepilépticos genéricos en el tratamiento de la epilepsia infantil / Role of generic antiepileptic drugs in the treatment of childhood epilepsy

La aparición de fármacos genéricos en el mercado, en sustitución de marcas registradas®, y las adecuadas regulaciones de las autoridades sanitarias en los distintos países ha condicionado hasta la actualidad una polémica sobre el riesgo costo/beneficio de tal sustitución en el paciente afecto de epilepsia. El binomio costo/beneficio debe dar por demostrado de manera clara que el paciente puede beneficiarse de tal sustitución sin correr riesgo alguno significativo. Por ello se valoran los distintos aportes en la literatura médica al respecto, que analizan estos riesgos y beneficios y en especial el hecho esencial de la bioequivalencia de ambas formulaciones, en especial en las situaciones de aquellos fármacos antiepilépticos de margen o índice terapéutico estrecho que hagan inviable la equivalencia de la biodisponibilidad del fármaco, la ausencia de repercusión clínica real en el paciente así como la evidencia que existe un beneficio económico claro al valorar el citado binomio riesgo/beneficio. La revisión efectuada señala la clara existencia de desventajas potenciales del cambio de un fármaco antiepiléptico (FAE) original de marca a un genérico como: distinta biodisponibilidad, bioequivalencia no demostrada, riesgo de reaparición de crisis en pacientes controlados y variabilidad de la respuesta de los FAE en el paciente epiléptico, imposible de predecir. Por ello se aconseja valorar la importancia de un fracaso terapéutico tras un cambio a genérico, en especial en casos de margen terapéutico estrecho, la biodisponibilidad permisible con valoración de la variabilidad individual del paciente, situación médico-legal de tal cambio y la realidad de los ahorros y costos potenciales derivados.

The use of generic instead of trade mark antiepileptic drugs raises the question of cost/benefit risks. The efficacy and side effects of the generic AED should be similar to the trade mark drugs. Otherwise, the substitution is not justified despite the benefits of reduced cost if efficacy or side effects are not similar in order to avoid possible recurrence of seizures with potential health hazard consequences and legal action. The purpose of this paper is to review the scientific medical literature to determine the efficacy and side effects of generic and trademark antiepileptic drugs.

Economic evaluation of seizures associated with solitary cysticercus granuloma.

BACKGROUND: Patients with solitary cysticercus granuloma (SCG) develop acute symptomatic seizures because of the inflammatory response of the brain and the seizures are self-limiting. Thus seizure disorder associated with SCG provides a good model to study the total cost of illness (COI). MATERIALS AND METHODS: COI of new-onset seizures associated with SCG was studied in 59 consecutive patients registered at the epilepsy clinic. Direct treatment-related costs and indirect costs, man-days lost and wages lost were evaluated. The relative cost was calculated as the percentage of per capita gross national product (GNP) at current prices for the year 1997-1998. RESULTS: The total COI, for treating seizure disorder associated with SCG per the period of CT resolution of the lesion per patient was INR 7273.7 (US$ 174.66, I$ 943.16) and he/she would be spending 50.9% of per capita GNP The direct cost per patient was INR 5916 (US$ 137.14, 41.4% of per capita GNP). If the patient had received only AEDs for the period of resolution of CT lesion, the cost would be INR 5702.48 (US$132.2, 40% of per capita GNP). The extra expenditure on albendazole and steroid was INR 213.72 (US$ 4.95), 3.6% of the total direct cost and 20.7% of the medication cost. Indirect cost (average wage loss) per patient was INR 1312.7 (US$ 30.42) and it accounted for 9% of per capita GNP. The one-time expenditure at present costs (adjusted for inflation) to the nation to treat all the prevalence cases is to the tune of INR 1.184 billion (US$ 2.605) and 0.0037% of GNP. CONCLUSIONS: This study suggests that seizure disorder associated with SCG, a potentially preventable disorder, is a good model to study the total COI. The one-time expenditure at present costs to the nation to treat all the prevalence cases of seizure disorder associated with SCG is to the tune of INR 1.184 billion (US$ 2.605 million) and 0.0037% of GNP.

Tratamento de epilepsia: consenso dos especialistas brasileiros / Treatment of epilepsy: consensus of the Brazilian specialists

Epilepsia é uma condição muito freqüente em todo o mundo. Na última década, várias opções terapêuticas surgiram ou foram aprimoradas. O principal método utilizado para decisão terapêutica baseia-se nos estudos randomizados, que representam o maior nível de evidência. Entretanto, mesmo estes estudos são passíveis de críticas e em alguns casos o tratamento de escolha permanece controverso. Nestas situações, a opinião dos especialistas, na área da epileptologia, com maior experiência clínica, passa a ter grande valor. O presente estudo tem como principal objetivo elaborar um consenso de tratamento das epilepsias, através da opinião de experts brasileiros no assunto. Este consenso poderá auxiliar na criação de manuais e estratégias para o tratamento de determinadas síndromes epilépticas, de acordo com os padrões socioeconômicos brasileiros

Money matters in epilepsy.

Cost of epilepsy care has escalated many folds in the recent past. The high cost of newer anti epileptic drugs, cost of elaborate presurgical evaluation and surgery account for a large component of direct medical cost. Indirect cost to the society, through lost productivity or premature death, is many times more than the direct cost. The newer drugs have an advantage over the conventional drugs in terms of tolerability, safety and ease of administration. The benefits in terms of better control of seizures and improvement in quality of life offered by these newer strategies in treatment of epilepsy need to be considered along with the increase in cost. Careful economic evaluation is essential to assess ultimate utility of these interventions in the management of epilepsy at large. Unfortunately, there is little data on this aspect for the physician to apply in his practice. The general principles of economic appraisal of epilepsy and some of the key works in this field are discussed in this paper. The increase in cost due to newer anti epileptic drugs in the treatment of unselected population of patients (mild and severe epilepsy) may not be adequately justified by gains in seizure control. On the other hand newer drugs may have a clear superiority in selected situations such as intractable seizures. The high initial cost of presurgical evaluation and epilepsy surgery may be offset by gains in increased number of quality adjusted life years.

Management of childhood epilepsy.

As "seizures beget seizures," it is essential to investigate the etiology and control seizures early. The multiplicity of causes, variability in the response to treatment and in the outcome, despite adequate treatment often create dilemmas for the physician. The best option for the clinician is to take cognizance of each reported symptom carefully, examine the patient thoroughly, elucidate the family history, examine the sequence of the disease process and tailor the prescription accordingly. The investigations should depend on the anticipated cause, keeping in view the cost benefit analysis and economic constraints with a simultaneous onus of not missing treatable causes. In addition, if the long term serious effects on social function are to be rectified, physicians must address these areas with equal enthusiasm to the drug treatment of childhood epilepsy. Development of newer antiepileptic drugs and rationalising epilepsy surgery will be the challenges of the coming millennium.