Mapping the Burden of Epilepsy by Comparative Evaluation of EQ-5D-5L and EQ-HWB-S for Quality-of-Life Assessment and Cost-Utility Analysis: A Prospective Observational Study

Introduction: Epilepsy strongly affects health-related quality of life (HRQoL) and psychosocial well-being. Quality of life (QoL) is commonly measured using standardized tools such as the EQ-5D-5L, which assesses HRQoL, and the newer EQ-HWB-S, which captures both health and well-being dimensions. The study aimed to assess the QoL and overall wellness of epilepsy patients using the EQ-5D-5L and EQ-HWB-S, compare their ability to capture patient outcomes, and evaluate the cost-effectiveness of epilepsy treatment through cost-utility analysis based on quality-adjusted life years (QALYs) and total treatment cost. Methods: A total of 108 epilepsy patients were recruited at a tertiary government medical college in India. Participants completed the EQ-5D-5L and EQ HWB-S questionnaires in their preferred language. Direct medical costs were recorded, and the cost per QALY was calculated. Results: The mean EQ-5D-5L utility score was 0.7463, while the mean EQ-HWB-S total score was 18. The Wilcoxon signed-rank test revealed a statistically significant difference, with EQ-HWB-S demonstrating greater sensitivity to psychosocial well-being. On average, each patient incurred a treatment cost of ₹18,765.74, and the mean cost-per-QALY was ₹50,300, well below the ₹1.9 lakh threshold, indicating high cost-effectiveness. Discussion: The comparative results indicate that EQ-HWB-S captures psychosocial and emotional domains more comprehensively than EQ-5D-5L, highlighting its additional clinical value in epilepsy assessment. Conclusion: EQ-HWB-S was more effective at capturing the mental, physical, and social burden of epilepsy than EQ-5D-5L. Epilepsy treatment in the public healthcare setting was found to be highly cost-effective. The combined use of both tools offers a comprehensive framework for guiding epilepsy care policy.