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Economic burden of epilepsy in children: A population‐based matched cohort study in Canada
Author(s) -
Widjaja Elysa,
Guttmann Astrid,
Tomlinson George,
Snead O. Carter,
Sander Beate
Publication year - 2021
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.16775
Subject(s) - medicine , epilepsy , confidence interval , cohort , socioeconomic status , health care , indirect costs , pediatrics , population , cohort study , demography , environmental health , psychiatry , business , accounting , sociology , economics , economic growth
Objective The economic burden of childhood epilepsy to the health care system remains poorly understood. This study aimed to determine phase‐specific and cumulative long‐term health care costs in children with epilepsy (CWE) from the health care payer perspective. Methods This cohort study utilized linked health administrative databases in Ontario, Canada. Incident childhood epilepsy cases were identified from January 1, 2003 to June 30, 2017. CWE were matched to children without epilepsy (CWOE) on age, sex, rurality, socioeconomic status, and comorbidities, and assigned prediagnosis, initial, ongoing, and final care phase based on clinical trajectory. Phase‐specific, 1‐year and 5‐year cumulative health care costs, attributable costs of epilepsy, and distribution of costs across different ages were evaluated. Results A total of 24 411 CWE were matched to CWOE. The costs were higher for prediagnosis and initial care than ongoing care in CWE. Hospitalization was the main cost component. The costs of prediagnosis, initial, and ongoing care were higher in CWE than CWOE, with the attributable costs at $490 (95% confidence interval [CI] = $352‐$616), $1322 (95% CI = $1247‐$1402), and $305 (95% CI = $276‐$333) per 30 patient‐days, respectively. Final care costs were lower in CWE than CWOE, with attributable costs at −$2515 (95% CI = −$6288 to $961) per 30 patient‐days. One‐year and 5‐year cumulative costs were higher in CWE ($14 776 [95% CI = $13 994‐$15 546] and $39 261 [95% CI = $37 132‐$41 293], respectively) than CWOE ($6152 [95% CI = $5587‐$6768] and $15 598 [95% CI = $14 291‐$17 006], respectively). The total health care costs were highest in the first year of life in CWE for prediagnosis, initial, and ongoing care. Significance Health care costs varied along the continuum of epilepsy care, and were mainly driven by hospitalization costs. The findings identified avenues for remediation, such as enhancing care around the time of epilepsy diagnosis and better care coordination for epilepsy and comorbidities, to reduce hospitalization costs and the economic burden of epilepsy care.