Background: Partial-onset seizures are the most common type of seizures in patients with epilepsy. In addition to the significant impact on patients, the unpredictability of seizures often also affects family members or caregivers. Caregiver burden in relation to patient treatment may help to guide treatment choices for patients. Quantitative evidence about the relationship between workplace absences, costs, and treatment burden among caregivers of patients with partial-onset seizures is lacking.
Objective: To compare direct and indirect healthcare costs and absences among employed caregivers of patients with partial-onset seizures who are receiving monotherapy or adjunctive therapy with antiepileptic drugs (AEDs).
Methods: This retrospective study analyzed data of employed caregiver spouses of patients with partial-onset seizures and paired them with the patients into 2 groups based on the patient's therapy: the monotherapy cohort or the adjunctive therapy cohort (ie, >90 days of concomitant use of ≥2 AEDs). Patients and caregivers had to have ≥12 months of continuous data after the index date. Separate 2-part regression models were used to compare direct medical and prescription costs; indirect costs (ie, sick leave, short-term and long-term disability, and workers' compensation); and differences in work absences for caregivers.
Results: The baseline caregivers' characteristics were similar in the monotherapy cohort (N = 238) and the adjunctive therapy cohort (N = 129). Caregivers' total direct costs were $4231 in the monotherapy cohort and $7217 in the adjunctive therapy cohort. The caregivers of patients in the monotherapy cohort were less likely to use inpatient hospital services than caregivers of patients in the adjunctive therapy cohort (1.3% vs 9.9%, respectively; P = .0016). The caregivers' total indirect costs were $912 and $1192 in the monotherapy and adjunctive therapy cohorts, respectively. Sick days were significantly lower in the monotherapy cohort (2.4 days vs 4.4 days annually; P <.0001), with an associated cost difference of $541.
Conclusion: Caregivers of patients with partial-onset seizures in the adjunctive therapy cohort had significantly greater medical and sick day costs than caregivers in the monotherapy cohort. These findings suggest that higher treatment burden among patients with epilepsy is associated with greater direct and indirect healthcare costs for their caregivers.
Keywords: absenteeism; adjunctive therapy; antiepileptic drugs; caregiver burden; caregivers; direct healthcare cost; epilepsy; indirect healthcare cost; monotherapy; partial-onset seizures; treatment decision-making.