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van Hezik-Wester V, de Groot S, Kanters T, Versteegh M, Wagner L, Ardesch J, Brouwer W, van Exel J. Burden of illness in people with medically refractory epilepsy who suffer from daily to weekly seizures: 12-month follow-up of participants in the EPISODE study. Front Neurol 2022; 13:1012486. [PMID: 36388190 PMCID: PMC9650114 DOI: 10.3389/fneur.2022.1012486] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/28/2022] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND A small group of people with epilepsy suffers from frequent seizures despite the available pharmacological and non-pharmacological interventions. The impact of epilepsy on these people extends beyond health-related quality of life (HRQoL), impacting a person's broader well-being and ability to participate in society. This study describes the burden of medically refractory epilepsy in people who suffer from daily to weekly seizures, in terms of HRQoL, well-being, and societal costs. METHODS Data from the EPISODE study on (cost-) effectiveness of seizure dogs for adults with severe medically refractory epilepsy were used, collected in 25 patients during the first 12 months before they were partnered with a certified seizure dog. Data comprised seizure diaries covering 365 days and five three-monthly surveys, including the EQ-5D-5L, QOLIE-31-P, and ICECAP-A to measure HRQoL and well-being. A societal perspective was applied to estimate costs using the iMCQ and iPCQ questionnaires about healthcare use, informal care, and productivity losses. RESULTS Daily seizure frequency and survey data were collected in 25 patients. A minimum of 114 observations was available for each instrument included in the survey. A total of 80% of participants experienced seizures on three or more days per week, with a median ranging from 1 to 17 seizures per seizure day. The mean EQ-5D-5L utility score was 0.682 (SD 0.235), which is considerably lower than the age-adjusted general population average. The mean QOLIE-31-P and ICECAP-A scores were 55.8 (SD 14.0) and 0.746 (SD 0.172), respectively. The average annual total cost amounted to €39,956 (range €3,804-€132,64). Informal care accounted for the largest share of costs (50%); those who received informal care reported, on average, 26 h per week (SD 30). CONCLUSIONS Severe medically refractory epilepsy is associated with a considerable burden of illness at the patient and societal level. People with this condition have significantly reduced HRQoL and well-being and are limited in their ability to work while having substantial medical costs and a strong dependency on informal care.
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Affiliation(s)
- Valérie van Hezik-Wester
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Saskia de Groot
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Tim Kanters
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Matthijs Versteegh
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Louis Wagner
- Kempenhaeghe and MUMC+, Academic Centre for Epileptology, Heeze, Netherlands
| | | | - Werner Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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Leenen LAM, Wijnen BFM, van Haastregt JCM, de Kinderen RJA, Evers SMAA, Majoie MHJM, van Heugten CM. Process evaluation of a multi-component self-management intervention for adults with epilepsy (ZMILE study). Epilepsy Behav 2017. [PMID: 28623752 DOI: 10.1016/j.yebeh.2017.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND People with epilepsy need to monitor and manage their symptoms. They, as well as their relatives, have to deal with the psychological burden, reflected in a reduced quality of life. Support in self-management can be of importance. We have developed a multi-component self-management intervention for patients and their relatives (MCI). This eight-week group intervention is conducted by nurse practitioners and consists of six two-hour sessions. The main components are: 1) providing self-management education, 2) stimulating proactive coping and goal-setting and 3) facilitating peer and social support. This study is a process evaluation to establish the feasibility, fidelity and acceptability of the intervention by assessing performance according to protocol, attendance and adherence, and the opinion of patients, relatives and facilitators about the intervention. METHOD Study population consists of 52 patients with epilepsy living in the community (e.g. at home), 37 relatives and six facilitators. In this prospective mixed methods study, data were gathered using questionnaires for patients and relatives, registration forms for facilitators and by carrying out semi-structured group interviews with patients, relatives and facilitators. RESULTS Patients and relatives attended a mean of 5.2 sessions. Forty-seven (90%) patients and 32 (86.5%) relatives attended at least five sessions. The mean group size was 8.1 (SD=1.3; range 6-10). All elements of the intervention were offered to participants, except for one e-Health tool which was only available at the start of the study. Overall, the sessions were considered useful by patients, their relatives and facilitators. The participation of a relative (social support) and sharing ideas and feelings about having epilepsy with peers (peer support) were rated as important aspects. CONCLUSION This process evaluation revealed that the MCI was largely performed according to protocol, attendance rate was high, and participants and facilitators had, on the whole, a favourable opinion about the MCI, and would recommend it to others with epilepsy and their relatives. Overall, the adherence of patients and relatives was high. The MCI is considered feasible according to patients, relatives and facilitators. Implementation is recommended if the intervention proves to be effective.
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Affiliation(s)
- Loes A M Leenen
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands; Department of Research & Development, Academic Centre of Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands; Department of Neurology, Academic Centre of Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands.
| | - Ben F M Wijnen
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands; Department of Research & Development, Academic Centre of Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands.
| | - Jolanda C M van Haastregt
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands.
| | - Reina J A de Kinderen
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Silvia M A A Evers
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI Care and Public Health Institute, Maastricht University, Maastricht, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Marian H J M Majoie
- Department of Research & Development, Academic Centre of Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands; Department of Neurology, Academic Centre of Epileptology Kempenhaeghe Maastricht UMC+, The Netherlands; School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands; School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Caroline M van Heugten
- School for Mental Health and Neuroscience (MHENS), Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Psychology and Neurosciences: Department of Neuropsychology and Psychopharmacology, Maastricht University, Maastricht, The Netherlands.
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