Impact of Epilepsy on Productivity and Quality of Life: The Australian Epilepsy Project.

Abstract

Epilepsy occurs in 4% of Australians over their lifetime. European studies show that over 75% of epilepsy-related health care costs are indirect, with 80% due to absenteeism. In Australia, studies capturing absenteeism in epilepsy are limited and presenteeism data are unavailable. This study investigated employment rates, absenteeism, presenteeism, and quality of life reported by people who experienced seizures in Australia. The Australian Epilepsy Project (AEP) is a prospective cohort study of adults with first unprovoked seizure (FUS), newly diagnosed epilepsy (NDE), or focal drug-resistant epilepsy (DRE), referred mainly from tertiary care clinics. This study is a cross-sectional analysis of AEP baseline data, reporting quality of life (EuroQol 5 Dimensions [EQ-5D-5L] and Quality of Life in Epilepsy Inventory [QOLIE-31]); employment rates; and the prevalence and extent of absenteeism and presenteeism, assessed using the Work Productivity and Activity Impairment questionnaire. Correlations were assessed using either Spearman or Pearson methods. Logistic regression was used for odds. Of 670 participants (median age 35.6 years, interquartile range [IQR] 26.9-47.3 years, 53.4% female participants), 15.9% had FUS, 34.6% had NDE, and 49.4% had DRE. The median (IQR) EQ-5D-5L score for the cohort was 0.93 (0.83-0.96). The mean QOLIE-31 score was lower for people with DRE (49.7 ± 16.8), compared with both NDE (57.9 ± 17.4, <i>p</i> = 0.003) and FUS (59.4 ± 16.2, <i>p</i> = 0.003) groups. The employment rate was 62.3% (95% CI 58.4%-66.1%), with lower rates in the DRE group (53.9% <i>p</i> < 0.001). 30.8% (95% CI 26.1%-35.7%) of workers reported absenteeism, 45% (95% CI 40.0%-50.0%) reported presenteeism, and 23% (95% CI 19.6%-28.5%) reported both. Among those with absenteeism, each year, full-time workers lost a median of 60 (IQR 31.5-189.4) days of work and part-time workers lost 37.8 (IQR 18.9-75.7) days of work. The mean percentage of presenteeism was higher in patients with DRE compared with those with NDE (22.9% vs 15.2%, <i>p</i> = 0.007). People with absenteeism and presenteeism had lower QOLIE-31 scores (mean difference -9.9, 95% CI -6.4 to -13.3, <i>p</i> < 0.001; -9.2, 95% CI -0.016 to -0.076, <i>p</i> < 0.001) than those without. Employment and work productivity are commonly reduced in people who experience seizures, particularly those with DRE. Lower productivity was associated with poorer quality of life. Further studies are needed to understand the nature of this relationship.