title: Quality of life and economic impact of refractory epilepsy in Spain: the ESPERA study.
abstract: BACKGROUND
  Despite use of currently available anti-epileptic drugs (AED), 30% of epilepsy patients are not seizure-free. The purpose of this study was to estimate the quality of life and economic impact in Spain of drug-resistant epilepsy (DRE), as defined by the International League Against Epilepsy (ILAE).
  
  
  METHODS
  Observational retrospective 12-month study conducted in Spain including adults with focal epilepsy treated with at least two AEDs. Direct costs (€ 2010) were calculated based on health care resources used and their official unit costs. Costs were analysed from the perspectives of the Spanish National Health System (SNS) and society. The impact of DRE on patients' quality of life was examined using the QOLIE 31-P, EQ-5D-3L, and NDDIE questionnaires.
  
  
  RESULTS
  We analysed 263 patients out of the 304 recruited. According to ILAE criteria, 70.0% of the patients had drug-resistant epilepsy, while 20.3% achieved seizure freedom. From the viewpoint of the SNS, annual costs for resistant and seizure-free patients were € 4964 and € 2978 respectively (P<.01). Compared to resistant patients, seizure-free patients showed better scores on QOLIE-31P (70.8 vs 56.4, P<.0001) and EQ-5D-3L (75.6 vs 64.7, P<.001). Seizure-free patients showed a lower incidence of major depression compared to resistant patients according to the NDDIE scale (23 vs 8.3%, P<.05).
  
  
  CONCLUSIONS
  Results suggest that DRE is associated with increased use of healthcare resources and consequently with higher costs, poorer quality of life and higher incidence of major depression compared to seizure-free patients, thus representing a considerable burden to the SNS and society.
authors: Unidad Multidisciplinar de Epilepsia, Servicio de Neurología, Hospital Universitario y Politécnico La Fe, Valencia, España. vevillanuevah@yahoo.es
authors: V
authors: V
authors: Villanueva
authors: J M
authors: JM
authors: Girón
authors: J
authors: J
authors: Martín
authors: L J
authors: LJ
authors: Hernández-Pastor
authors: J
authors: J
authors: Lahuerta
authors: M
authors: M
authors: Doz
authors: M
authors: M
authors: Cuesta
authors: L
authors: L
authors: Lévy-Bachelot
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000209:etiology / Q000523:psychology; D004351:Drug Resistance; D004827:Epilepsy / Q000191:economics* / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires