Burden of epilepsy: a prevalence-based cost of illness study of direct, indirect and intangible costs for epilepsy

OBJECTIVES: We aimed to gauge the burden of epilepsy in China from a societal perspective by estimating the direct, indirect and intangible costs. METHODS: Patients with epilepsy and controls were enrolled from two tertiary hospitals in China. Patients were asked to complete a Cost-of-Illness (COI), Willingness-to-Pay (WTP) questionnaires, two utility elicitation instruments and Mini Mental State Examination (MMSE). Healthy controls only completed WTP questionnaire, and utility instruments. Univariate analyses were performed to investigate the differences in cost on the basis of different variables, while multivariate analysis was undertaken to explore the predictors of cost/cost component. RESULTS: In total, 141 epilepsy patients and 323 healthy controls were recruited. The median total cost, direct cost and indirect cost due to epilepsy were US$949.29, 501.34 and 276.72, respectively. Particularly, cost of anti-epileptic drugs (AEDs) (US$394.53) followed by cost of investigations (US$59.34), cost of inpatient and outpatient care (US$9.62) accounted for the majority of the direct medical costs. While patients' (US$103.77) and caregivers' productivity costs (US$103.77) constituted the major component of indirect cost. The intangible costs in terms of WTP value (US$266.07 vs. 88.22) and utility (EQ-5D, 0.828 vs. 0.923; QWB-SA, 0.657 vs. 0.802) were both substantially higher compared to the healthy subjects. CONCLUSIONS: Epilepsy is a cost intensive disease in China. According to the prognostic groups, drug-resistant epilepsy generated the highest total cost whereas patients in seizure remission had the lowest cost. AED is the most costly component of direct medical cost probably due to 83% of patients being treated by new generation of AEDs.

Locating the intangible: integrating a sense of place into cost estimations of natural disasters

The field of disaster loss assessment attempts to provide comprehensive estimates of the cost of disasters. Assessment of intangibles remains a major weakness. Existing costing frameworks have acknowledged losses to cultural – as distinct from economic, social, human or environmental – capital. However, theinclusion of cultural line items has usually been conducted in an ad hoc and under-theorised way, withlittle empirical evidence. This paper presents the possibility of using cultural capital itself as an overarchingcategory for specifically cultural losses. It further focuses on the specific concept of sense of place asone area that has been neglected even in frameworks that consider other kinds of intangibles, and argues,on both theoretical and pragmatic grounds, that a collective or shared sense of place can be subsumedwithin cultural capital loss estimates. Christchurch provides an illustration of the idea as relevant andcomparable empirical material is available from before and since the 2011 earthquake.