Epilepsia, 48(5):990–1001, 2007 Blackwell Publishing, Inc. C  2007 International League Against Epilepsy ILAE Commission Report Cross-Country Measures for Monitoring Epilepsy Care ∗ Charles E. Begley, †Gus A. Baker, ‡Ettore Beghi, §James Butler, ¶Daniel Chisholm, ∗∗ John T. Langfitt, ††Pierre Levy, ‡‡Christoph Pachlatko, §§Samuel Wiebe, and ¶¶Karen Lee Donaldson on behalf of the ILAE Commission on Healthcare Policy ∗ School of Public Health, University of Texas, U.S.A.; †Division of Neurosciences, University of Liverpool, Liverpool, United Kingdom; ‡Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; §Department of Neurology, University of Stellenbosch, Johannesburg, South Africa; ¶ Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland; ∗∗ Department of Neurology, University of Rochester School of Medicine, Rochester, U.S.A.; ††Place du Marechal de Lattre de Tassigny, Universite Paris-Dauphine, Paris, France; ‡‡Swiss Epilepsy Centre, Switzerland; §§Division of Neurology, Foothills Medical Centre, Calgary, Canada; ¶¶ Epilepsy Action, Leeds, U.K. Summary: Purpose: The International League Against Epilepsy (ILAE) Commission on Healthcare Policy in consulta- tion with the World Health Organization (WHO) examined the applicability and usefulness of various measures for monitoring epilepsy healthcare services and systems across countries. The goal is to provide planners and policymakers with tools to analyze the impact of healthcare services and systems and evaluate efforts to improve performance. Methods: Commission members conducted a systematic lit- erature review and consulted with experts to assess the nature, strengths, and limitations of the treatment gap and resource avail- ability measures that are currently used to assess the adequacy of epilepsy care. We also conducted a pilot study to determine the feasibility and applicability of using new measures to as- sess epilepsy care developed by the WHO including Disability- Adjusted Life Years (DALYs), responsiveness, and financial fair- ness. Results: The existing measures that are frequently used to assess the adequacy of epilepsy care focus on structural or pro- cess factors whose relationship to outcomes are indirect and may vary across regions. The WHO measures are conceptually supe- rior because of their breadth and connection to articulated and agreed upon outcomes for health systems. However, the WHO measures require data that are not readily available in developing countries and most developed countries as well. Conclusion: The epilepsy field should consider adopting the WHO measures in country assessments of epilepsy burden and healthcare performance whenever data permit. Efforts should be made to develop the data elements to estimate the measures. Key Words: Healthcare—Evaluation—International—Survey A major contributor to the global burden of epilepsy is the lack of adequate healthcare services, particularly in de- veloping countries but also in parts of developed countries as well. One of the greatest challenges to health planners and policymakers is obtaining meaningful data to mea- sure these inadequacies at the community or country level. While it is easy to conceptualize indicators that might pro- vide some insights, obtaining the data can be difficult. Relatively simple measures that have been developed to assess the adequacy of epilepsy healthcare at the coun- Accepted October 23, 2006. Address correspondence and reprint requests to Charles E. Beg- ley, School of Public Health, The University of Texas Health Science Center, 1200 Herman Pressler, Houston, Texas 77030, U.S.A. E-mail: charles.e.begley@uth.tmc.edu doi: 10.1111/j.1528-1167.2007.00981.x try level are the treatment gap and availability of key re- sources. These measures have been useful because they provide a basic indication of unmet need and require data that is relatively easy to obtain for most countries. In the 1990s, the World Health Organization (WHO) defined a broader set of healthcare measures to be used across diseases and countries to assess healthcare performance. Disability-Adjusted Life Years (DALYs) is proposed as an indicator of the health effects of healthcare systems. Patients’ perceptions of treatment responsiveness are pro- posed as a measure. Financial fairness defined as health- care spending relative to capacity to pay (CTP) is proposed as a measure. Over the last 3 years, the members of the Interna- tional League Against Epilepsy (ILAE) Commission on Healthcare Policy examined the general strengths and 990