title: Costs of epilepsy and cost-driving factors in children, adolescents, and their caregivers in Germany.
abstract: OBJECTIVE
  To provide first data on the cost of epilepsy and cost-driving factors in children, adolescents, and their caregivers in Germany.
  
  
  METHODS
  A population-based, cross-sectional sample of consecutive children and adolescents with epilepsy was evaluated in the states of Hessen and Schleswig-Holstein (total of 8.796 million inhabitants) in all health care sectors in 2011. Data on socioeconomic status, course of epilepsy, and direct and indirect costs were recorded using patient questionnaires.
  
  
  RESULTS
  We collected data from 489 children and adolescents (mean age ± SD 10.4 ± 4.2 years, range 0.5-17.8 years; 264 [54.0%] male) who were treated by neuropediatricians (n = 253; 51.7%), at centers for social pediatrics ("Sozialpaediatrische Zentren," n = 110, 22.5%) and epilepsy centers (n = 126; 25.8%). Total direct costs summed up to €1,619 ± €4,375 per participant and 3-month period. Direct medical costs were due mainly to hospitalization (47.8%, €774 ± €3,595 per 3 months), anticonvulsants (13.2%, €213 ± €363), and ancillary treatment (9.1%, €147 ± €344). The total indirect costs amounted to €1,231 ± €2,830 in mothers and to €83 ± €593 in fathers; 17.4% (n = 85) of mothers and 0.6% (n = 3) of fathers reduced their working hours or quit work because of their child's epilepsy. Independent cost-driving factors were younger age, symptomatic cause, and polytherapy with anticonvulsants. Older age, active epilepsy, symptomatic cause, and polytherapy were independent predictors of higher antiepileptic drug (AED) costs, whereas younger age, longer epilepsy duration, symptomatic cause, disability, and parental depression were independent predictors for higher indirect costs.
  
  
  CONCLUSIONS
  Treatment of children and adolescents with epilepsy is associated with high direct costs due to frequent inpatient admissions and high indirect costs due to productivity losses in mothers. Direct costs are age-dependent and higher in patients with symptomatic epilepsy and polytherapy. Indirect costs are higher in the presence of a child's disability and parental depression.
authors.affiliation: Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.|Department of Pediatrics and Neonatology, Justus-Liebig-University, Giessen, Germany.
authors.forename: Janna
authors.initials: J
authors.lastname: Riechmann
authors.affiliation: Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.|Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany.
authors.forename: Adam
authors.identifier: http://orcid.org/0000-0001-6288-9915
authors.initials: A
authors.lastname: Strzelczyk
authors.affiliation: Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.|Institute of Medical Sociology and Social Medicine, Philipps-University Marburg, Marburg, Germany.
authors.forename: Jens P
authors.initials: JP
authors.lastname: Reese
authors.affiliation: Department of Pediatric Neurology and Northern German Epilepsy Centre for Children and Adolescents, Kiel University, Kiel, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Boor
authors.affiliation: Department of Pediatric Neurology and Northern German Epilepsy Centre for Children and Adolescents, Kiel University, Kiel, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stephani
authors.affiliation: Private Neuropediatric Practice, Fulda, Germany.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Langner
authors.affiliation: Department of Pediatric Neurology, Justus-Liebig-University, Giessen, Germany.
authors.forename: Bernd A
authors.initials: BA
authors.lastname: Neubauer
authors.affiliation: Center for Social Pediatrics Frankfurt Höchst, Frankfurt/Main, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Oberman
authors.affiliation: Center for Social Pediatrics and Epilepsy Outpatient Clinic Frankfurt Mitte, Frankfurt/Main, Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Philippi
authors.affiliation: Private Neuropediatric Practice, Königstein, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Rochel
authors.affiliation: Center for Social Pediatrics and Epilepsy Outpatient Clinic Frankfurt Mitte, Frankfurt/Main, Germany.|Department of Pediatrics, Deutsche Klinik für Diagnostik, Wiesbaden, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Seeger
authors.affiliation: Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.|Department of Pediatrics, Philipps-University Marburg, Marburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Seipelt
authors.affiliation: Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Oertel
authors.affiliation: Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Dodel
authors.affiliation: Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.|Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University, Frankfurt am Main, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Rosenow
authors.affiliation: Epilepsy Center Erlangen, Friedrich-Alexander University, Erlangen, Germany.
authors.forename: Hajo M
authors.initials: HM
authors.lastname: Hamer
mesh_terms: D000293:Adolescent; D017028:Caregivers / Q000191:economics* / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004827:Epilepsy / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D012044:Regression Analysis; D011795:Surveys and Questionnaires
keywords: Caregiver burden; Indirect costs; Resource use; Seizures; Work loss