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Riechmann J, Willems LM, Boor R, Kieslich M, Knake S, Langner C, Neubauer BA, Oberman B, Philippi H, Reese JP, Rochel M, Schubert-Bast S, Seeger J, Seipelt P, Stephani U, Rosenow F, Hamer HM, Strzelczyk A. Quality of life and correlating factors in children, adolescents with epilepsy, and their caregivers: A cross-sectional multicenter study from Germany. Seizure 2019; 69:92-98. [PMID: 31004927 DOI: 10.1016/j.seizure.2019.03.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/30/2019] [Accepted: 03/24/2019] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To identify factors correlating with poorer quality of life (QoL) in children and adolescents with epilepsy and regarding QoL and depression of their caregivers in Germany. METHOD A cross-sectional multicenter study on QoL and depression was performed in two representative German states (Hessen and Schleswig-Holstein). Variance analysis, linear regression, and bivariate correlation were used to identify correlating factors for poorer QoL and symptoms of depression. RESULTS Data from 489 children and adolescents (mean age 10.4 ± 4.2 years, range 0.5-17.8; 54.0% male) and their caregivers were collected. We identified missing seizure freedom (p = 0.046), concomitant diseases (p = 0.007), hospitalization (p = 0.049), recent status epilepticus (p = 0.035), living in a nursing home or with foster parents (p = 0.049), and relevant degree of disability (p = 0.007) to correlate with poorer QoL in children and adolescents with epilepsy. Poorer QoL of caregivers was associated with longer disease duration (p = 0.004), non-idiopathic (mainly structural-metabolic) epilepsy (p = 0.003), ongoing seizures (p = 0.003), concomitant diseases (p = 0.003), relevant disability (p = 0.003), or status epilepticus (p = 0.003) as well as with unemployment of the primary caretaker (p = 0.010). Symptoms of depression of caregivers were associated with non-idiopathic epilepsy (p = 0.003), concomitant diseases (p = 0.003), missing seizure freedom (p = 0.007), status epilepticus (p = 0.004), or a relevant disability (p = 0.004) of their ward. A poorer QoL value of the children and adolescents correlated with a poorer QoL value of the caregivers (p < 0.001). CONCLUSIONS Epilepsy shows a considerable impact on QoL and symptoms of depression. Early and effective therapy should focus on reduction of seizure frequency and the probability for developing status epilepticus. Furthermore, comprehensive care should pay attention at comorbidities, consequences of disability and dependency on others.
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Affiliation(s)
- Janna Riechmann
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany; Department of Pediatrics, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Rainer Boor
- Department of Pediatric Neurology and Northern German Epilepsy Centre for Children and Adolescents, Christian-Albrechts-University, Kiel, Germany
| | - Matthias Kieslich
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Susanne Knake
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | | | - Bernd A Neubauer
- Department of Pediatric Neurology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Bettina Oberman
- Center for Social Pediatrics Frankfurt Höchst, Frankfurt am Main, Germany
| | - Heike Philippi
- Center for Social Pediatrics and Epilepsy Outpatient Clinic Frankfurt Mitte, Frankfurt am Main, Germany
| | - Jens P Reese
- Coordinating Center for Clinical Trials, Philipps-University Marburg, Marburg (Lahn), Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | | | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany; Department of Neuropediatrics, Goethe-University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Jürgen Seeger
- Center for Social Pediatrics and Epilepsy Outpatient Clinic Frankfurt Mitte, Frankfurt am Main, Germany
| | - Peter Seipelt
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany; Department of Pediatrics, Philipps-University Marburg, Marburg (Lahn), Germany
| | - Ulrich Stephani
- Department of Pediatric Neurology and Northern German Epilepsy Centre for Children and Adolescents, Christian-Albrechts-University, Kiel, Germany
| | - Felix Rosenow
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Hajo M Hamer
- Epilepsy Center Erlangen, Friedrich-Alexander University, Erlangen, Germany
| | - Adam Strzelczyk
- Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe University Frankfurt, Frankfurt am Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.
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Pankatz M, Stachow R, Reese JP. Studiendesign zur Entwicklung eines Fragebogens zur Identifikation der Motivationsstufe bei Jugendlichen mit Adipositas. Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gerlach N, Reese JP. Prevalence of gender role targeting in studies of disease and health deficiencies. Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Linssen F, Reese JP. Regionale Unterschiede von Diabeteskomplikationen: Versorgungsepidemiologie am Beispiel Mexiko. Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pankatz M, Hampel P, Reese JP, Tiedjen U, Stachow R. Ergebnisse einer telefonischen Rehanachsorge nach stationärer Adipositasrehabilitation. Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Riechmann J, Strzelczyk A, Reese JP, Boor R, Stephani U, Langner C, Neubauer BA, Oberman B, Philippi H, Rochel M, Seeger J, Seipelt P, Oertel WH, Dodel R, Rosenow F, Hamer HM. Costs of epilepsy and cost-driving factors in children, adolescents, and their caregivers in Germany. Epilepsia 2015; 56:1388-97. [PMID: 26235849 DOI: 10.1111/epi.13089] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/28/2022]
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. SIGNIFICANCE 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.
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Affiliation(s)
- Janna Riechmann
- Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.,Department of Pediatrics and Neonatology, Justus-Liebig-University, Giessen, Germany
| | - Adam Strzelczyk
- 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
| | - Jens P Reese
- Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.,Institute of Medical Sociology and Social Medicine, Philipps-University Marburg, Marburg, Germany
| | - Rainer Boor
- Department of Pediatric Neurology and Northern German Epilepsy Centre for Children and Adolescents, Kiel University, Kiel, Germany
| | - Ulrich Stephani
- Department of Pediatric Neurology and Northern German Epilepsy Centre for Children and Adolescents, Kiel University, Kiel, Germany
| | | | - Bernd A Neubauer
- Department of Pediatric Neurology, Justus-Liebig-University, Giessen, Germany
| | - Bettina Oberman
- Center for Social Pediatrics Frankfurt Höchst, Frankfurt/Main, Germany
| | - Heike Philippi
- Center for Social Pediatrics and Epilepsy Outpatient Clinic Frankfurt Mitte, Frankfurt/Main, Germany
| | | | - Jürgen Seeger
- Center for Social Pediatrics and Epilepsy Outpatient Clinic Frankfurt Mitte, Frankfurt/Main, Germany.,Department of Pediatrics, Deutsche Klinik für Diagnostik, Wiesbaden, Germany
| | - Peter Seipelt
- Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.,Department of Pediatrics, Philipps-University Marburg, Marburg, Germany
| | - Wolfgang H Oertel
- Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany
| | - Richard Dodel
- Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany
| | - Felix Rosenow
- 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
| | - Hajo M Hamer
- Epilepsy Center Erlangen, Friedrich-Alexander University, Erlangen, Germany
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Strzelczyk A, Schubert-Bast S, Reese JP, Rosenow F, Stephani U, Boor R. Evaluation of health-care utilization in patients with Dravet syndrome and on adjunctive treatment with stiripentol and clobazam. Epilepsy Behav 2014; 34:86-91. [PMID: 24727467 DOI: 10.1016/j.yebeh.2014.03.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 03/16/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Abstract
Dravet syndrome (DS) is a rare, severe childhood epilepsy syndrome that imposes a substantial burden on patients and their caregivers. This study evaluated health-care utilization over a 2-year period in patients with DS at an outpatient clinic of a German epilepsy center. Data on the course of epilepsy, anticonvulsant treatment, and direct costs were recorded using the electronic seizure diary Epivista and patients' files. We enrolled 13 patients with DS (6 females, mean age: 12.3±7.5 years) between 2007 and 2010 and evaluated them during a 1-year baseline. All patients had drug-resistant epilepsy and their seizures failed to improve with a mean number of 6.7±3.4 anticonvulsants. They had an overall mean seizure frequency of 102.1 seizures per year (median: 31, range: 3-538) with 43.2 GTCSs per year (median: 14, range: 0-228). We estimated the annual total direct costs at €6506±3974 (range: €1174-11,783) per patient with hospitalization (68.9% of total direct costs) as the major cost factor ahead of costs for anticonvulsants (24.0%). For the 1-year follow-up period, less severely affected patients were continued on conventional anticonvulsants (n=4) or switched to adjunctive treatment with stiripentol and clobazam (n=9). In the latter group, six patients (67%) were long-term responders, with between 25% and 100% seizure reduction with respect to either GTCSs or the overall seizure frequency. This reduction in seizure frequency was associated with a shift in the distribution of cost components towards higher medication costs and decreased hospitalization costs. The total direct costs increased by 42.7%, mainly due to the newly introduced stiripentol, with an annual cost of €6610. This study showed that direct costs of patients with DS were above the average European costs of drug-resistant epilepsy in children. Treatment with new anticonvulsants resulted in reduction of seizures and inpatient admissions.
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Affiliation(s)
- Adam Strzelczyk
- Department of Neurology, Epilepsy Center Hessen, Philipps-University, Marburg, Germany.
| | - Susanne Schubert-Bast
- Center for Child and Adolescent Medicine, Section Neuropediatrics, Ruprecht-Karls University, Heidelberg, Germany
| | - Jens P Reese
- Department of Neurology, Epilepsy Center Hessen, Philipps-University, Marburg, Germany; Institute of Medical Sociology and Social Medicine, Philipps-University, Marburg, Germany
| | - Felix Rosenow
- Department of Neurology, Epilepsy Center Hessen, Philipps-University, Marburg, Germany
| | - Ulrich Stephani
- Department of Pediatric Neurology, Kiel University, Germany; Northern German Epilepsy Centre for Children and Adolescents, Raisdorf, Germany
| | - Rainer Boor
- Department of Pediatric Neurology, Kiel University, Germany; Northern German Epilepsy Centre for Children and Adolescents, Raisdorf, Germany
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Dams J, Bornschein B, Siebert U, Volkmann J, Deuschl G, Oertel WH, Reese JP, Dodel R. Die Kosten-Effektivität der Tiefen Hirnstimulation für Patienten mit Morbus Parkinson. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Bücking B, Balzer-Geldsetzer M, Dodel R, Ruchholtz S, Reese JP, Gehrke J. Factors influencing short-term functional recovery of geriatric hip fracture patients - a prospective observational study. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Reese JP. Comparative Effectiveness Research - Aktuelle Anwendung und methodische Grenzen. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Strzelczyk A, Haag A, Reese JP, Nickolay T, Oertel WH, Dodel R, Knake S, Rosenow F, Hamer HM. Trends in resource utilization and prescription of anticonvulsants for patients with active epilepsy in Germany. Epilepsy Behav 2013; 27:433-8. [PMID: 23591262 DOI: 10.1016/j.yebeh.2013.03.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 03/09/2013] [Accepted: 03/11/2013] [Indexed: 10/27/2022]
Abstract
This study evaluated trends in the resource use of patients with active epilepsy over a 5-year period at an outpatient clinic of a German epilepsy center. Two cross-sectional cohorts of consecutive adults with active epilepsy were evaluated over a 3-month period in 2003 and 2008. Data on socioeconomic status, course of epilepsy, as well as direct and indirect costs were recorded using validated patient questionnaires. We enrolled 101 patients in 2003 and 151 patients in 2008. In both cohorts, 76% of the patients suffered from focal epilepsy, and the majority was on antiepileptic drug (AED) polytherapy (mean AED number: 1.7 (2003), 1.8 (2008)). We calculated epilepsy-specific costs of € 2955 in 2003 and € 3532 in 2008 per 3 months per patient. Direct medical costs were mainly due to anticonvulsants in 2003 (59.4% of total direct costs, 34.0% in 2008) and to hospitalization in 2008 (46.9% of total direct costs, 27.7% in 2003). The proportion of enzyme-inducing anticonvulsants and 'old' AEDs decreased between 2003 and 2008. Indirect costs of € 1689 and € 1847 were mainly due to early retirement (48.4%; 46.0% of total indirect costs in 2003; 2008), unemployment (26.1%; 24.2%), and days off due to seizures (25.5%; 29.8%). This study showed a shift in distribution of direct cost components with increased hospital costs as well as a cost-neutral increase in the prescription of 'newer' AEDs. The amount and distribution of indirect cost components remained unchanged.
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Affiliation(s)
- Adam Strzelczyk
- Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.
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Dams J, Klotsche J, Bornschein B, Reese JP, Balzer-Geldsetzer M, Winter Y, Schrag A, Siderowf A, Oertel WH, Deuschl G, Siebert U, Dodel R. Mapping the EQ-5D index by UPDRS and PDQ-8 in patients with Parkinson's disease. Health Qual Life Outcomes 2013; 11:35. [PMID: 23497005 PMCID: PMC3662160 DOI: 10.1186/1477-7525-11-35] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 02/19/2013] [Indexed: 12/02/2022] Open
Abstract
Background Clinical studies employ the Unified Parkinson’s Disease Rating Scale (UPDRS) to measure the severity of Parkinson’s disease. Evaluations often fail to consider the health-related quality of life (HrQoL) or apply disease-specific instruments. Health-economic studies normally use estimates of utilities to calculate quality-adjusted life years. We aimed to develop an estimation algorithm for EuroQol- 5 dimensions (EQ-5D)-based utilities from the clinical UPDRS or disease-specific HrQoL data in the absence of original utilities estimates. Methods Linear and fractional polynomial regression analyses were performed with data from a study of Parkinson’s disease patients (n=138) to predict the EQ-5D index values from UPDRS and Parkinson’s disease questionnaire eight dimensions (PDQ-8) data. German and European weights were used to calculate the EQ-5D index. The models were compared by R2, the root mean square error (RMS), the Bayesian information criterion, and Pregibon’s link test. Three independent data sets validated the models. Results The regression analyses resulted in a single best prediction model (R2: 0.713 and 0.684, RMS: 0.139 and 13.78 for indices with German and European weights, respectively) consisting of UPDRS subscores II, III, IVa-c as predictors. When the PDQ-8 items were utilised as independent variables, the model resulted in an R2 of 0.60 and 0.67. The independent data confirmed the prediction models. Conclusion The best results were obtained from a model consisting of UPDRS subscores II, III, IVa-c. Although a good model fit was observed, primary EQ-5D data are always preferable. Further validation of the prediction algorithm within large, independent studies is necessary prior to its generalised use.
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Affiliation(s)
- Judith Dams
- Department of Neurology, Philipps-University, Marburg, Germany
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Strzelczyk A, Reese JP, Oertel WH, Dodel R, Rosenow F, Hamer HM. Costs of epilepsy and their predictors: Cross-sectional study in Germany and review of literature. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.epilep.2013.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Reese JP, Stiasny-Kolster K, Oertel WH, Dodel RC. Health-related quality of life and economic burden in patients with restless legs syndrome. Expert Rev Pharmacoecon Outcomes Res 2012; 7:503-21. [PMID: 20528395 DOI: 10.1586/14737167.7.5.503] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Restless legs syndrome (RLS) is characterized by a distressing, irresistible need or urge to move the legs. It often co-exists with an uncomfortable, though not usually painful, sensation in the legs. Although clear diagnostic criteria and effective treatment options exist, RLS is generally underdiagnosed and under-treated. RLS patients often suffer from sleep disturbances that may severely disrupt normal life functioning. Furthermore, it is one of the most common neurological disorders. In this communication, we provide a systematic review of the literature on health-related quality of life (HRQoL) and health economic issues in patients suffering from RLS. RLS has a considerable impact on the HRQoL of patients, which is comparable to other neurological and chronic diseases. The most important factors contributing to the impairment of HRQoL are the severity of RLS symptoms and the associated sleep disturbances. Although little work has been published on cost-of-illness of RLS, available studies suggest that a considerable economic burden is caused by RLS. Because of the large number of patients requiring treatment and the considerable increase in the number of treatment studies performed in recent years, as well as approval of several drugs for this indication, we assume a considerable increase in treatment frequency. Very few of the RLS treatment options, however, have been evaluated for their cost-effectiveness, and further research is needed on both quality-of-life issues and the economic impact of RLS.
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Affiliation(s)
- Jens P Reese
- Philipps-University Marburg, Department of Neurology, Rudolf-Bultmannstr. 8, 35039 Marburg, Germany
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Reese JP, Dams J, Winter Y, Balzer-Geldsetzer M, Oertel WH, Dodel R. Pharmacoeconomic considerations of treating patients with advanced Parkinson's disease. Expert Opin Pharmacother 2012; 13:939-58. [PMID: 22475391 DOI: 10.1517/14656566.2012.677435] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is one of the most common neurodegenerative diseases. In the later (advanced) stages of PD, the initial treatment of early PD becomes less effective and long-term side effects of dopaminergic treatment become apparent. In advanced PD, motor and non-motor complications occur, which increase treatment costs. Increasing disability and impaired activities of daily living concomitantly raise indirect costs, due to loss in productivity. Hence, the economic burden of advanced PD is substantial for both the society and the patients with their caregivers. AREAS COVERED A systematic literature search was performed involving the databases NHS CRD (National Health Service Centre for Reviews and Dissemination) and PubMed until July 15, 2011. "Parkinson" [Mesh] and "cost" were used as search terms in PubMed and only "Parkinson" in the CRD database. EXPERT OPINION Economic evaluations are scarce and heterogeneous, and their interpretation may be limited due to methodological shortcomings. Dopamine agonists, COMT and MAO-B inhibitors as well levodopa infusion and deep brain stimulation are reported to be cost-effective in the respective decision frameworks. However, these results are heavily dependent on assumptions of drug costs and effect sizes used in the models. More detailed real-life information from long-term clinical trials is needed to feed the economic models, especially for head-to-head comparisons. To date, no economic evaluation has been undertaken for possible neuroprotective/disease modifying effects, and further research is needed for evaluations of interventions for non-motor symptoms.
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Affiliation(s)
- Jens P Reese
- Philipps-University Marburg, Department of Neurology, Baldingerstrasse, 35043 Marburg, Germany
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Strzelczyk A, Nickolay T, Bauer S, Haag A, Knake S, Oertel WH, Reif PS, Rosenow F, Reese JP, Dodel R, Hamer HM. Evaluation of health-care utilization among adult patients with epilepsy in Germany. Epilepsy Behav 2012; 23:451-7. [PMID: 22381385 DOI: 10.1016/j.yebeh.2012.01.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 01/09/2012] [Indexed: 10/28/2022]
Abstract
This study evaluated the resource use of patients with epilepsy in the German district of Marburg-Biedenkopf. A cross-sectional cohort of consecutive adults with epilepsy, irrespective of seizure severity, duration of illness and epilepsy syndrome, was investigated in all health-care sectors. Costs of inpatient and outpatient treatment were derived from billing data of participating hospitals and office-based physicians. Data on socioeconomic status, course of epilepsy and further direct and indirect costs were recorded using patient questionnaires. We enrolled 366 patients from the district of Marburg-Biedenkopf and calculated annual epilepsy-specific costs of €7738 per patient. Direct costs contributed 31.1% (€2406) and indirect costs 68.9% (€5332) of the total costs. Direct medical costs were mainly due to hospitalization (33.2% of total direct costs) and anticonvulsants (26.7%). Costs of admissions were due to status epilepticus (24.4%), video-EEG monitoring (14.8%), newly diagnosed patients (14.4%) and seizure-related injuries (8.8%). Indirect costs were mainly due to early retirement (38.0%), unemployment (35.9%) and days off due to seizures (26.2%). The mean costs of epilepsy found in our study were lower than those found in studies conducted at European epilepsy centers due to the inclusion of patients in all health-care sectors.
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Affiliation(s)
- Adam Strzelczyk
- Department of Neurology and Epilepsy Center Hessen, Philipps-University, Marburg, Germany.
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Reese JP, Winter Y, Rosa MM, Rodrigues E Silva AM, von Campenhausen S, Freire R, Mateus C, Balzer-Geldsetzer M, Botzel K, Oertel WH, Dodel R, Sampaio C. [Health-economic burden of Parkinson's disease in Portugal: a cohort study]. Rev Neurol 2011; 52:264-274. [PMID: 21341221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION Parkinson's disease (PD) is a common neurodegenerative disorder with a considerable socioeconomic burden. Health-economic evaluations of PD in the Southern European countries are limited. AIM To evaluate the costs of PD in an outpatient cohort in Portugal. PATIENTS AND METHODS 49 consecutive PD patients were recruited at the neurological outpatient clinic of the University of Lisbon between October 2004 and December 2005. Clinical status was evaluated using the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr stages. Costs were assessed from the societal perspective using health-economic questionnaires. Human capital approach was used to estimate indirect costs. Health-related quality of life was evaluated by means of the EQ-5D. RESULTS Direct costs were 2,717 euros (95% CI = 1,147-3,351) per patient for a six-month period. Main contributors to the direct costs included drugs (544 euros; 95% CI = 426-6,940) and hospitalizations (690 euros; 95% CI = 229-1,944). Indirect costs amounted to 850 euros (95% CI = 397-1,529), whereas patient expenditures constituted 12% of direct costs. Assistance by family and other relatives played a major role. In general, costs were lower than in other Western countries. CONCLUSIONS The economic burden of PD in Portugal is considerable. Important cost components include medications and hospitalizations. More research is needed in order to describe a comprehensive health service patterns in Portugal and to guide health policy decisions more effectively.
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Affiliation(s)
- J P Reese
- Department of Neurology, Philipps, University Marburg, Marburg, Alemania
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von Campenhausen S, Winter Y, Rodrigues e Silva A, Sampaio C, Ruzicka E, Barone P, Poewe W, Guekht A, Mateus C, Pfeiffer KP, Berger K, Skoupa J, Bötzel K, Geiger-Gritsch S, Siebert U, Balzer-Geldsetzer M, Oertel WH, Dodel R, Reese JP. Costs of illness and care in Parkinson's disease: an evaluation in six countries. Eur Neuropsychopharmacol 2011; 21:180-91. [PMID: 20888737 DOI: 10.1016/j.euroneuro.2010.08.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 06/17/2010] [Accepted: 08/05/2010] [Indexed: 11/16/2022]
Abstract
We investigated the costs of Parkinson's Disease (PD) in 486 patients based on a survey conducted in six countries. Economic data were collected over a 6-month period and presented from the societal perspective. The total mean costs per patient ranged from EUR 2620 to EUR 9820. Direct costs totalled about 60% to 70% and indirect costs about 30% to 40% of total costs. The proportions of costs components of PD vary notably; variations were due to differences in country-specific health system characteristics, macro economic conditions, as well as frequencies of resource use and price differences. However, inpatient care, long-term care and medication were identified as the major expenditures in the investigated countries.
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Affiliation(s)
- Sonja von Campenhausen
- Department of Neurology, Philipps University Marburg, Rudolf-Bultmann-Strasse 8, Marburg, Germany
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19
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Reese JP, Winter Y, Rosa MM, Rodrigues e Silva AM, von Campenhausen S, Freire R, Mateus C, Balzer Geldsetzer M, Bötzel K, Oertel WH, Dodel R, Sampaio C. Estudio de cohortes sobre la carga socioeconómica de la enfermedad de Parkinson en Portugal. Rev Neurol 2011. [DOI: 10.33588/rn.5205.2010492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Winter Y, Bezdolnyy Y, Katunina E, Avakjan G, Reese JP, Klotsche J, Oertel WH, Dodel R, Gusev E. Incidence of Parkinson's disease and atypical parkinsonism: Russian population-based study. Mov Disord 2010; 25:349-56. [DOI: 10.1002/mds.22966] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Winter Y, von Campenhausen S, Reese JP, Balzer-Geldsetzer M, Longo K, Spiga G, Boetzel K, Eggert K, Oertel WH, Dodel R, Barone P. Costs of Parkinson’s Disease and Antiparkinsonian Pharmacotherapy: An Italian Cohort Study. NEURODEGENER DIS 2010; 7:365-72. [DOI: 10.1159/000302644] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 03/15/2010] [Indexed: 11/19/2022] Open
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22
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Schrader J, Deuster O, Rinn B, Schulz M, Kautz A, Dodel R, Meyer B, Al-Abed Y, Balakrishnan K, Reese JP, Bacher M. Restoration of contact inhibition in human glioblastoma cell lines after MIF knockdown. BMC Cancer 2009; 9:464. [PMID: 20038293 PMCID: PMC2810303 DOI: 10.1186/1471-2407-9-464] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Accepted: 12/28/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies of the role of the cytokine macrophage-migration-inhibitory-factor (MIF) in malignant tumors have revealed its stimulating influence on cell-cycle progression, angiogenesis and anti-apoptosis. RESULTS Here we show that in vitro targeting MIF in cultures of human malignant glioblastoma cells by either antisense plasmid introduction or anti-MIF antibody treatment reduced the growth rates of tumor cells. Of note is the marked decrease of proliferation under confluent and over-confluent conditions, implying a role of MIF in overcoming contact inhibition. Several proteins involved in contact inhibition including p27, p21, p53 and CEBPalpha are upregulated in the MIF antisense clones indicating a restoration of contact inhibition in the tumor cells. Correspondingly, we observed a marked increase in MIF mRNA and protein content under higher cell densities in LN18 cells. Furthermore, we showed the relevance of the enzymatic active site of MIF for the proliferation of glioblastoma cells by using the MIF-tautomerase inhibitor ISO-1. CONCLUSION Our study adds another puzzle stone to the role of MIF in tumor growth and progression by showing the importance of MIF for overcoming contact inhibition.
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Affiliation(s)
- Jörg Schrader
- Department of Neurology, University of Marburg, Marburg, Germany.
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23
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John A, Wienemann G, Reese JP, Wellek A, Hagen BV, Dodel R, Tackenberg B, Balzer-Geldsetzer M. Longitudinale Studie zu Lebensqualität und Versorgung bei Patienten mit Multipler Sklerose. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Winter Y, Reese JP, Campenhausen SV, Eggert K, Balzer-Geldsetzer M, Klotsche J, Freire R, Brozova H, Longo K, Peter H, Gasser J, Seppi K, Popov G, Mateus C, Pfeiffer KP, Skoupa J, Boetzel K, Gusev E, Guekht A, Ruzicka E, Barone P, Sampaio C, Poewe W, Oertel WH, Dodel R. Health-related quality of life and pharmacotherapy in Parkinson's disease: results of a multi-country study of the EuroPA Study Group. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dams J, Klotsche J, Bornschein B, Reese JP, Siebert U, Dodel R. Verwendung des UPDRS und PDQ-8 zur Vorhersage des EQ-5D Index für Patienten mit Parkinson Krankheit. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Reese JP, Balzer-Geldsetzer M, Dodel R, Becker E, Christopher A, Friedrich H, Kraemer S, Lüer W, Müngersdorf M, Puzich R, Rohr A, Schultes-Platzek I, Siefjediers V, Tiel-Wilck K, Ehret R. Inanspruchnahme medizinischer Leistungen und Versorgungsmuster von Parkinson-Patienten in neurologischen Schwerpunktpraxen in Berlin (NeuroPa-Studie). Akt Neurol 2009. [DOI: 10.1055/s-0029-1238652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Parkinson's disease is one of the most common chronic neurodegenerative diseases. The progression of disease and the psychosocial consequences exert a major impact on patients' health-related quality of life. Although levodopa provides the best symptomatic benefit with the fewest short-term adverse effects, long-term treatment results in motor complications that are associated with both higher costs and considerable increase in patients' discomfort. The introduction of dopamine agonists early in the treatment of Parkinson's disease leads to a delay of these motor complications, but the treatment is associated with higher costs.In this review we evaluate available cost-effectiveness analyses of the dopamine agonists pramipexole, pergolide, bromocriptine, ropinirole, cabergoline and levodopa in the treatment of early Parkinson's disease. Considerable methodological differences in the identified studies complicate a comparison and impede clear evidence as to which dopamine agonist treatment is the most cost effective in early Parkinson's disease. Novel head-to-head comparisons considering the actual treatment guidelines are necessary to identify the most cost-effective alternative in treating de novo Parkinson's disease patients.
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Affiliation(s)
- Karla M Eggert
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
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Winter Y, von Campenhausen S, Popov G, Reese JP, Klotsche J, Bötzel K, Gusev E, Oertel WH, Dodel R, Guekht A. Costs of illness in a Russian cohort of patients with Parkinson's disease. Pharmacoeconomics 2009; 27:571-584. [PMID: 19663528 DOI: 10.2165/11310160-000000000-00000] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The economic burden associated with Parkinson's disease (PD) is increasing as the worldwide population ages. While cost-of-illness studies for PD from developed countries have recently been published, data for Eastern Europe and Asia are still lacking. OBJECTIVE To prospectively evaluate direct and indirect costs in a cohort of Russian patients with PD in order to identify cost-driving factors. METHODS AND PATIENTS We recruited 100 patients with idiopathic PD who visited the outpatient department for movement disorders of the Russian Medical State University in Moscow between October 2004 and December 2005. The Unified Parkinson's Disease Rating Scale was used to evaluate clinical status. Economic data were collected in a 'bottom-up' approach and evaluated from the societal perspective. Indirect costs were estimated using a human capital approach. Russian currency was converted into euro, year 2005 values, using the purchasing power parity. All costs were then inflated to euro, year 2008 values, using the Medical Care Component of the Consumer Price Index. Independent cost predictors were identified by means of multivariate regression analyses. RESULTS From the societal perspective, total costs per patient over 6 months amounted to euro2620 (95% CI 2050, 3200), with direct costs accounting for 67% and indirect costs for 33% of the total. Patients' expenditures accounted for 43% of their private income. The primary burden on patients was due to informal care and drugs. Only 10% of home care was provided by the formal service sector. Costs for the nation are estimated at euro1.1 billion per year. CONCLUSION The economic burden of PD in Russia is considerable, especially when taking into account low private incomes. Further development of a formal care system and better reimbursement systems for drugs are necessary in Russia.
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Affiliation(s)
- Yaroslav Winter
- Department of Neurology, Philipps University Marburg, Marburg, Germany
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Unger MM, Reese JP, Oertel WH, Eggert KM. Real-Life Evaluations of Compliance with Mandatory Drug Safety Monitoring Exemplified with Tolcapone in Parkinson’s Disease. Eur Neurol 2008; 60:122-6. [DOI: 10.1159/000144081] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Accepted: 01/06/2008] [Indexed: 11/19/2022]
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