Costs of Epilepsy in Austria: Unemployment as a primary driving factor.

PURPOSE: Epilepsy is one of the most common chronic neurological disorders, and long-term treatment with antiseizure medication is often central to its management. The costs of antiseizure medication are more evident than other disease-related costs; thus, we assessed the direct and indirect costs of epilepsy focusing on both drug expenditure and other cost-driving factors. METHODS: Outpatient records and questionnaires applied in a tertiary epilepsy centre in Vienna were used in this bottom-up cost-of-illness study to evaluate disease duration, age at onset, epilepsy syndrome, seizure frequency, sex, healthcare utilisation, diagnostic evaluations, antiseizure medication, and occupation. Cost data were clustered in a histogram-based data analysis, and multivariate regressions were performed to identify cost drivers. RESULTS: The average annual costs of 273 patients amounted to €9,256 ($10,459): €4,486 ($5,069) direct costs and €4,770 ($5,390) indirect costs. A histogram of semi-annual costs revealed distinct groups with low costs (< €2,500 = $2,825) and high costs (> €2,500 = $2,825). Seizure-free patients were clustered in the group with low costs; patients with ongoing seizures appeared more frequently in the group with high costs. Working patients were more often found in the group with low costs, whereas unemployed patients were more prevalent in the group with high costs. The regression analysis confirmed worklessness as the main cost driver. CONCLUSION: Non-productivity and poorly controlled disease with ongoing seizures are associated with higher costs in epilepsy. Providing high-level care and optimal drug treatment that enables patients to remain in work may help reduce the economic burden of epilepsy.

Clinical performance of resin-bonded fixed partial dentures and extracoronal attachments for removable prostheses.

STATEMENT OF PROBLEM: It is important to evaluate the long-term clinical performance of resin-bonded fixed partial dentures and extracoronal attachments for removable prostheses. PURPOSE: A prospective, long-term clinical study was conducted to evaluate the success of resin-bonded fixed partial dentures since 1985 and of resin-bonded extracoronal attachments from 1987. METHODS: Until 1993, a total of 130 resin-bonded fixed partial dentures had been seated in 101 patients, as well as 12 removable partial dentures (RPDs) with 24 extracoronal retainers in 10 patients. The clinical treatment protocol and the laboratory procedures were standardized. By the end of 1993, it was possible to reexamine 98 patients with a total of 127 resin-bonded fixed partial dentures and all 10 patients with removable partial dentures. The average time in function for the resin-bonded fixed partial dentures at the time of examination was 3.4 years and 2.3 years for the removable restorations. RESULTS: During the period of observation, one retainer failed on six of the resin-bonded fixed partial dentures, which represents a failure rate of 4.7%. Debonding of extracoronal attachments was recorded for 8.3% of the total number of retainers. CONCLUSION: The resin-bonded fixed partial denture technique can be considered to be a clinically reliable method of treatment, and permits the expansion of indications beyond a classical three-unit resin-bonded fixed partial denture. Long-term clinical success of removable partial dentures with resin-bonded extracoronal retainers warrants additional clinical studies.