Total costs of epilepsy care may extend well beyond those associated with primary management of the condition, new data presented at the AAN Annual Meeting confirm. Costs for management of comorbidities, including mental health disorders, can significantly increase the overall costs to third-party payors and employers.

A 12-month retrospective analysis of costs associated with epilepsy found higher rates of mental disorders, substance abuse, and other neurological and physical disorders among patients with epilepsy compared to those without the condition. On average, the analysis showed, direct costs for third-party payors (medical, pharmaceutical costs, etc.) were nearly three times higher for patients with epilepsy versus those without. Interestingly, expenses related to health issues other than epilepsy accounted for 80 percent of insurers' total annual costs for epilepsy patients

In a second study investigating indirect costs associated with epilepsy, costs were also three times higher—or about $6,400 higher per patient—for individuals with epilepsy versus others.

The study was sponsored by Johnson & Johnson Pharmaceutical Services, Inc. in conjunction with Ortho-McNeil Neurologics. The latter also sponsored and presented a study analyzing dialogue between neurologists and epilepsy patients.

According to results of the study, topics of mood and behavior were not generally discussed during epilepsy patients' visits with neurologists, while one out of four visits lacked discussion of AED side effects.

The study involved audio- and video-recording of office visits as well as surveys of physicians and patients assessing what they discussed in office visits. Only 13 of 60 visits (22 percent) included discussion of mood and behavior, 57 percent of patients reporting irritability, depression, anxiety, hyperactivity, or other mood effects in post-visit surveys. Many neurologists admitting post-visit that they are uncomfortable addressing mood/behavior, believing they are the domain of other physicians.

Discussion of mood and behavior may be especially important now, in light of recent FDA mandate of class-wide label changes for AEDs. Last month, FDA updated its order that manufacturers, "Update product labeling to include a warning about an increased risk of suicidal thoughts or actions and...develop a Medication Guide to help patients understand this risk." The only drugs excluded from the rule are those indicated only for short-term use.

In April, the agency approved label changes for all of the following: Carbatrol, Celontin, Depakene, Depakote ER, Depakote sprinkles, Depakote tablets, Dilantin, Equetro, Felbatol, Gabitril, Keppra, Keppra XR, Klonopin, Lamictal, Lyrica, Mysoline, Neurontin, Peganone, Stavzor, Tegretol, Tegretol XR, Topamax, Tranxene, Tridione, Trileptal, Zarontin, Zonegran, and generics. For more information, log on to: www.fda.gov/CDER/Drug/infopage/antiepileptics/default.htm.