title: Driving cost factors in adult outpatients with refractory epilepsy: a daily clinical practice in clinics of neurology in Spain.
abstract: OBJECTIVE
  To explore the association between patient-reported-outcomes measurements and costs in adult outpatients with drug refractory epilepsy (DRE) in Spain.
  
  
  METHODS
  Secondary analysis of a cross-sectional study to determine resources utilization and related costs of refractory epilepsy in Spain (LINCE study). Consecutive adult outpatients fulfilling criteria for DRE were analyzed. Health-related quality of life (HRQoL), anxiety and depression, self-perceived health status and patient's satisfaction with treatment were assessed respectively by QOLIE-10, HAD scales, EQ-5D-VAS and SATMED-Q questionnaire. Costs were estimated from public tariffs computing healthcare and non-healthcare resources use in the year 2005.
  
  
  RESULTS
  Seven hundred sixty two consecutive patients (728 (95.5%) valuables; 50.8% males, 40.5+/-13.5 years) were analyzed. Severe levels of anxiety and depression were both associated with higher costs: from a mean yearly total cost of 6291 euros +/- 7748 (no anxiety) to 10325.8 euros +/-9900.8 (severe), p<0.0012 and from 5983.5 euros +/-6726.1 (no depression) to 12691.4 euros +/-11745.9 (severe), p<0.0001. Total yearly cost was inversely associated with HRQoL, self-perceived health status and satisfaction with treatment: from 11517.3 euros +/-11449.2 to 5430.2 euros +/-7776.6, first and tenth QOLIE-10 decile intervals, respectively, from 11494 euros +/- 11668 to 5334.3 +/- 7606, first and tenth VAS decile intervals, respectively, and from 9762.6 euros +/- 9956.6 to 4746.4 euros +/- 5616.7, first and tenth SATMED-Q decile intervals, respectively, p<0.0001.
  
  
  CONCLUSIONS
  Higher costs of refractory epilepsy were associated with poorer patient-reported-outcomes scores. These findings may be of interest for both health decision makers and clinicians when evaluating the resources devoted to epilepsy.
authors.affiliation: Department of Neurology, General University Hospital, Valencia, Spain. pilar_pena@yahoo.com
authors.forename: Pilar
authors.initials: P
authors.lastname: Peña
authors.forename: Jerónimo
authors.initials: J
authors.lastname: Sancho
authors.forename: Miguel
authors.initials: M
authors.lastname: Rufo
authors.forename: Silvia
authors.initials: S
authors.lastname: Martínez
authors.forename: Javier
authors.initials: J
authors.lastname: Rejas
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000191:economics*; D003365:Costs and Cost Analysis / Q000379:methods; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000188:drug therapy / Q000191:economics* / Q000503:physiopathology / Q000523:psychology*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000191:economics*; D017063:Outcome Assessment, Health Care / Q000379:methods; D011788:Quality of Life; D012044:Regression Analysis; D012189:Retrospective Studies; D012649:Self Concept; D013030:Spain