Medical Alert
Although different studies have shown that diseases such as breast or lung cancer are associated with specific bodily odours, no study has yet tested the possibility that epileptic seizures may be reflected in an olfactory profile, probably because there is a large variety of seizure types. The question is whether a “seizure-odour”, that would be transversal to individuals and types of seizures, exists. This would be a pre requisite for potential anticipation, either by electronic systems (e.g., e-noses) or trained dogs. The aim of the present study therefore was to test whether trained dogs, as demonstrated for cancer or diabetes, may discriminate a general epileptic seizure odor (different from body odours of the same person in other contexts and common to different persons). The results were very clear: all dogs discriminated the seizure odour. The sensitivity and specificity obtained were amongst the highest shown up to now for discrimination of diseases. This constitutes a first proof that, despite the variety of seizures and individual odours, seizures are associated with olfactory characteristics. These results open a large field of research on the odour signature of seizures. Further studies will aim to look at potential applications in terms of anticipation of seizures.
No abstract.
PURPOSE: Gather data on incidence of canine alerting/responding behavior with a defined patient population. Research development and use of purported alerting dogs. METHODS: Review of the literature was performed. A qualitative questionnaire was completed by epilepsy patients. Service dog trainers were identified. RESULTS: Of 63 patients, 29 owned pet dogs. Nine reported their dog responded to seizures, three also were reported to alert to seizure onset. There was no significant evidence of correlation between alerting/responding behavior and the patients’ demographics, health, or attitude/opinion of pets. Seizure-alerting/responding behavior of the dog did not appear to depend on its age, gender or breed. A literature review revealed psychological and practical benefits of service dogs are well documented. Fifteen trainers of seizure-assist dogs were identified and interviewed. CONCLUSIONS: Findings suggest some dogs have innate ability to alert and/or respond to seizures. Suggests a trend in type of seizure/auras a dog may alert to. Success of these dogs depends largely on the handler’s awareness and response to the dog’s alerting behavior. Warrants further research to aid in the selection of patients who may benefit from seizure-assist dogs, for identification and further training of these dogs and possibly the development of seizure-alerting devices.
The study was approved by the Human Institutional Review Board and the Animal Care and Use Committee at Legacy Research Institute (Portland, OR). Trained dogs were largely unable to identify skin swabs obtained from hypoglycemic T1D subjects. We chose to test with skin swabs because 1) dogs are well known to respond to scents carried on human skin (1) and 2) the trainers had reported success with this method in training the animals to respond to hypoglycemia. To our knowledge, this is the first controlled study to address whether dogs can detect a hypoglycemic scent, though there are anecdotal and case reports suggesting that dogs can respond to hypoglycemia (2–4). Our results addressed only whether there is a detectable hypoglycemia scent on the skin. In future studies, it may be helpful to include behavioral elements, such as studies in the presence of human companions. It might also be helpful to obtain swabs from the usual human companions of the dogs. We found that trained dogs were unable to correctly identify skin swabs obtained during hypoglycemia in subjects with T1D. Further studies are needed to address the role of other factors that the animals might use, such as behavioral cues.
Noting the human inclination to extend ability by “harvesting” nonhuman animal powers, there are calls for greater equality in the multispecies rendering of services. In this study, medical alert assistance dogs who coexist with chronically ill human individuals illustrate the possibilities of mutualism in symbiotic relationships. The dogs are trained to alert and are used in the scent detection of symptoms of hypo- or hyperglycemia in their human partners so that preventative treatment can be effected and unconsciousness or coma avoided. The canine-human collaborative partnership is based on the dogs’ keen sense of smell and cooperation to attain a reward. The article illustrates a cross-species embodiment of moral interdependence that extends the biomedical armamentarium.
To gain information about their clients’ experiences, SDWR conducted an online survey, which was completed by 36 DAD owners—23 parents of children and 13 adults with type 1 diabetes (means/standard deviations of child/adult age 8.4/3.1 and 36.4/14.1, respectively). Data were deidentified by SDWR then sent to the University of Virginia for analysis, and the study was approved as exempt by the University of Virginia Institutional Review Board. Survey items inquired about the accuracy of DAD alerts, as well as frequency of hypoglycemia, diabetes control, and QoL prior to and since DAD placement.
Introduction: Hypoglycemia (Hypo) is the most common side effect of insulin therapy in people with type 1 diabetes (T1D). Over time, patients with T1D become unaware of signs and symptoms of Hypo. Hypo unawareness leads to morbidity and mortality. Diabetes alert dogs (DADs) represent a unique way to help patients with Hypo unawareness. Our group has previously presented data in abstract form which demonstrates the sensitivity and specificity of DADS. The purpose of our current study is to expand evaluation of DAD sensitivity and specificity using a method that reduces the possibility of trainer bias.
Methods: We evaluated 6 dogs aging 1–10 years old who had received an average of 6 months of training for Hypo alert using positive training methods. Perspiration samples were collected from patients during Hypo (BG 46–65 mg/dL) and normoglycemia (BG 85–136 mg/dl) and were used in training. These samples were placed in glass vials which were then placed into 7 steel cans (1 Hypo, 2 normal, 4 blank) randomly placed by roll of a dice. The dogs alerted by either sitting in front of, or pushing, the can containing the Hypo sample. Dogs were rewarded for appropriate recognition of the Hypo samples using a food treat via a remote control dispenser. The results were videotaped and statistically evaluated for sensitivity (proportion of lows correctly alerted, ‘‘true positive rate’’) and specificity (proportion of blanks ? normal samples not alerted, ‘‘true negative rate’’) calculated after pooling data across all trials for all dogs.
Results: All DADs displayed statistically significant (p value \0.05) greater sensitivity (min 50.0%–max 87.5%) to detect the Hypo sample than the expected random correct alert of 14%. Specificity ranged from a min of 89.6% to a max of 97.9% (expected rate is not defined in this scenario).
Conclusions: Our results suggest that properly trained DADs can successfully recognize and alert to Hypo in an in vitro setting using smell alone.
Evidence supporting seizure-related behaviors in dogs is emerging. The methods of seizure response dog (SRD) training programs are unstudied. A standardized survey was retrospectively applied to graduates of a large SRD program. Subjective changes in quality of life (QOL) parameters were explored. Data were captured on animal characteristics, training methods, response and alerting behaviors, effects on seizure frequency, and accuracy of epilepsy diagnosis. Twenty-two patients (88%) participated (median age = 34, range = 12–66, 73% female). Most had childhood-onset epilepsy (87%) that was refractory with averages of 36 seizures/month and 4.8 medications failed. All had neurologist-confirmed epilepsy, most being symptomatic partial (64%). SRD behaviors were reliable, including emergency response system activation in 27%. All reported SRD-related QOL improvements (major 82%, moderate 18%) across multiple parameters. Spontaneous alerting behavior developed in 59%. That SRD programs may select genuine epilepsy patients, instill valuable assistance skills, and generate meaningful QOL improvements supports further seizure dog research.
Purpose
We sought to assess whether a dog can be trained to distinguish obstructive sleep apnea patients from healthy controls based on the olfactory detection of urine.
Methods
Urine samples were collected from 23 adult male obstructive sleep apnea patients and from 20 voluntary adult male volunteers. Three dogs were trained through reinforced operant conditioning.
Results
Two of the three dogs correctly detected two thirds of obstructive sleep apnea patients (p < 0.000194 and p < 0.000003, respectively).
Conclusions
We found that dogs can be trained to distinguish obstructive sleep apnea patients from healthy controls based on the smell of urine. Potentially, dogs could be utilized to identify novel biomarkers or possibly screen for obstructive sleep apnea.
Abstract
Seizure unpredictability plays a major role in disability and decreased quality of life in people with epilepsy. Dogs have been used to assist people with disabilities and have shown promise in detecting seizures. There have been reports of trained seizure-alerting dogs (SADs) successfully detecting when a seizure is occurring or indicating imminent seizures, allowing patients to take preventative measures. Untrained pet dogs have also shown the ability to detect seizures and provide comfort and protection during and after seizures. Dogs’ exceptional olfactory abilities and sensitivity to human cues could contribute to their seizure-detection capabilities. This has been supported by studies in which dogs have distinguished between epileptic seizure and non-seizure sweat samples, probably though the detection of volatile organic compounds (VOCs). However, the existing literature has limitations, with a lack of well-controlled, prospective studies and inconsistencies in reported timings of alerting behaviours. More research is needed to standardize reporting and validate the results. Advances in VOC profiling could aid in distinguishing seizure types and developing rapid and unbiased seizure detection methods. In conclusion, using dogs in epilepsy management shows considerable promise, but further research is needed to fully validate their effectiveness and potential as valuable companions for people with epilepsy.
Introduction
The unpredictability of epileptic seizures is considered an important threat to the quality of life of a person with epilepsy. Currently, however, there are no tools for seizure prediction that can be applied to the domestic setting. Although the information about seizure-alert dogs – dogs that display changes in behavior before a seizure that are interpreted by the owner as an alert – is mostly anecdotal; living with an alerting dog (ADassistance dog) has been reported to improve quality of life of the owner by reducing the stress originating from the unpredictability of epileptic seizures and, sometimes, diminishing the seizure frequency.
Aim of the study
The aim of the study was to investigate, at an international level, the behaviors displayed by trained and untrained dogs that are able to anticipate seizures and to identify patient- and dog-related factors associated with the presence or absence of alerting behavior.
Methodology
An online questionnaire for dog owners with seizures was designed. Information about the participants (demographics, seizure type, presence of preictal symptoms) and their dogs (demographics, behavior around the time of seizures) was collected. In addition, two validated scales were included to measure the human–dog relationship (Monash Dog–Owner Relationship scale (MDORS)) and five different traits of the dogs’ personality (Monash Canine Personality Questionnaire refined (MCPQ-R)).
Results
Two hundred and twenty-seven responses of people experiencing seizures were received from six participant countries: 132 from people with dogs that had started alerting spontaneously, 10 from owners of trained AD, and the rest from owners of dogs that did not display any alerting behavior (nonalerting dog (NAD)). Individuals’ gender, age, or seizure type did not predict the presence of alerting behavior in their dogs. People who indicated that they experience preictal symptoms were more likely to have a spontaneously AD. The owner–dog bond was significantly higher with ADs compared with NADs, and ADs scored significantly higher than NADs in the personality traits “Amicability”, “Motivation”, and “Training focus”.
Conclusion
This study collected a large group of dog owners with seizures reporting behavioral changes in their dogs before their seizures occurred. This was associated with the presence of preictal symptoms. The seizure-alerting behavior of the dog may have a positive influence on the bond between the owner and the dog.
This article examines the social experiences of Service Dog handlers using survey data from adult US Service Dog handlers (N = 482). The main research question examined is how disability visibility impacts the experiences of Service Dog-related discrimination. Analysis reveals that half of all Service Dog handlers report experiencing discrimination but those with invisible disabilities report experiencing significantly more discrimination. For those with invisible disabilities, the decision to use a Service Dog prevents them from ‘passing’ while at the same time opening them up to increased skepticism about the legitimacy of their disability.
One of the life threatening complications of diabetes is hypoglycaemia. It is a common complication, with times of greatest risk being before meals and during the night. Symptoms usually develop when the blood glucose level falls below 3.5 mmol/l. Many patients with long-standing diabetes report loss of warning symptoms. Prevention of such hypoglycaemic attacks is highly desirable. Recently a dog’s ability to detect hypoglycaemia in diabetic patients has been recorded. This is the first recorded case of hypoglycaemia in a non-diabetic patient being detected by a dog and also we believe it to be the first report of hypoglycaemia being detected by a dog in this country (Ireland).
Aims: Patients with diabetes increasingly have questions about diabetes alert dogs. This study evaluated perceptions about dogs trained professionally or otherwise to detect glucose levels. Methods: A link to a survey about glucose detecting dogs was announced on diabetes websites. Results: 135 persons responded, with 63 answering about their child with diabetes. Most respondents obtained their dog from a professional trainer (n=54) or trained it themselves(n=51). Owners of self and professionally-trained dogs were very positive about dogs’ abilities to alert them to low and high glucose levels, while owners of dogs that learned entirely on their own (n=15) reported lower frequencies of alerts and more missed hypo-glycemic episodes, p<.01. Regardless of how dogs learned, perceptions about managing diabetes were improved during periods of dog ownership relative to times without, p<.001. Self-reported rates of diabetes-related hospitalizations, assistance from others for treating hypoglycemia, and accidents or near accidents while driving reduced during periods of dog ownership compared to periods without dogs, ps<.01. Conclusions: These data suggest potential effectiveness of and high satisfaction with glucose-detecting dogs. Clinicians can use these results to address pros and cons of dog ownership with patients who inquire about them.
Epilepsy or the occurrence of epileptic seizures, is one of the world’s most well-known neurological disorders affecting millions of people. Seizures mostly occur due to non-coordinated electrical discharges in the human brain and may cause damage, including collapse and loss of consciousness. If the onset of a seizure can be forecast then the subject can be placed into a safe environment or position so that self-injury as a result of a collapse can be minimised. However there are no definitive methods to predict seizures in an everyday, uncontrolled environment. Previous studies have shown that pet dogs have the ability to detect the onset of an epileptic seizure by scenting the characteristic volatile organic compounds exuded through the skin by a subject prior a seizure occurring and there are cases where assistance dogs, trained to scent the onset of a seizure, can signal this to their owner/trainer. In this work we identify how we can automatically detect the signalling behaviours of trained assistance dogs and use this to alert their owner. Using data from an accelerometer worn on the collar of a dog we describe how we gathered movement data from 11 trained dogs for a total of 107 days as they exhibited signalling behaviour on command. We present the machine learning techniques used to accurately detect signalling from routine dog behaviour. This work is a step towards automatic alerting of the likely onset of an epileptic seizure from the signalling behaviour of a trained assistance dog.
This paper explores the intersection of assistance dog welfare and intelligent systems with a technological intervention in the form of an emergency canine alert system. We make the case that assistance dog welfare can be affected by the welfare of their human handlers, and examine the need for a canine alert system that enables the dog to take control over a potentially distressing situation thus improving assistance dog welfare. We focus on one specific subset of assistance dogs, the Diabetes Alert Dog, who are trained to warn their diabetic handlers of dangerously low or high blood sugar levels.
Purpose: To qualitatively describe and compare the expectations and experiences of living with a mobility or medical service dog among those with a physical disability or chronic condition.
Materials and methods: A total of 64 participants living with a service dog and 27 on the waitlist to receive a service dog participated in a cross-sectional open-ended survey. Qualitative content analysis was used to identify themes and sub-themes.
Results: A total of 101 codes were summarized into themes of Physical Benefits, Psychosocial Benefits, and Drawbacks to having a service dog. Psychosocial benefits included the human–animal relationship as well as emotional, quality of life, and social benefits. Drawbacks included service dog care, public access and education, lifestyle adjustments, and dog behaviour. While participants on the waitlist were more likely to anticipate physical benefits of having a service dog, those with a service dog largely described psychosocial benefits. Findings also suggest that some drawbacks, such as public discrimination, may be unanticipated by the waitlist.
Conclusions: A comparison of expectations and experiences of service dog ownership highlights both the positive and negative aspects of the service dog–owner relationship and identifies potential aspects of having a service dog that may be unanticipated or overestimated by those on the waitlist.
Implications for Rehabilitation
When asked about helpful and important aspects of having a service dog, 98% of service dog owners described the psychosocial benefits of their dog’s assistance and companionship.
The human–animal relationship was the most discussed psychosocial benefit from both current owners as well as those on the waitlist, demonstrating the unique strength of the service dog–owner bond in this population.
Those on the waitlist to receive a service dog did not anticipate as many drawbacks as current owners described. In particular, difficulties with public access and education as well as dog behaviour were commonly experienced, but not expected, drawbacks to service dog ownership.
Findings identify aspects of having a service dog that may be unanticipated or overestimated by those on the waitlist, providing rehabilitation professionals with a basis for preparing those who may be considering incorporating a service dog into their lives.
Objective: To quantify Diabetes Alert Dog (DAD) performance by using owner-independent measures.
Research Design and Methods: Eight owners of accredited DADs used a FreeStyle Libre Flash Glucose Monitoring System (FGMS). Concurrent Closed Circuit Television (CCTV) footage was collected for between 5 and 14 days in each owner’s home or workplace. The footage was blind-coded for dogs’ alerting behaviors. The sensitivity, False Positive Rate and Positive Predictive Values (PPV) of dogs’ alerts to out-of-range (OOR) episodes were calculated. Ratings for 11 attributes describing participant’s lifestyle and compliance (taken from each dog’s instructor) and the percentage of DAD alerts responded to by the owner as per training protocol (taken from CCTV footage) were assessed for association with dog performance.
Results: Dogs alerted more often when their owners’ glucose levels were outside vs. inside target range (hypoglycaemic 2.80-fold, p = 0.001; hyperglycaemic 2.29-fold, p = 0.005). Sensitivity to hypoglycaemic episodes ranged from 33.3 to 91.7%, the mean was 55.9%. Mean PPV for OOR episodes was 69.7%. Sensitivity and PPV were associated with aspects of the dog and owner’s behavior, and the owner’s adherence to training protocol.
Conclusions: Owner-independent methods support that some dogs alert to hypo- and hyperglycaemic events accurately, but performance varies between dogs. We find that DAD performance is affected by traits and behaviors of both the dog and owner. Combined with existing research showing the perceived psychosocial value and reduced critical health care needs of DAD users, this study supports the value of a DAD as part of a diabetes care plan. It also highlights the importance of ongoing training and continued monitoring to ensure optimal performance.
No abstract is available.
Background: Epilepsy is associated with a high disease burden, impacting the lives of people with epilepsy and their caregivers and family. Persons with medically refractory epilepsy experience the greatest burden, suffering from profound physical, psychological, and social consequences. Anecdotal evidence suggests these persons may benefit from a seizure dog. As the training of a seizure dog is a substantial investment, their accessibility is limited in the absence of collective reimbursement as is seen in the Netherlands. Despite sustained interest in seizure dogs, scientific knowledge on their benefits and costs remains scarce. To substantiate reimbursement decisions stronger evidence is required. The EPISODE study aims to provide this evidence by evaluating the effectiveness and cost-effectiveness of seizure dogs in adults with medically refractory epilepsy.
Methods: The study is designed as a stepped wedge randomized controlled trial that compares the use of seizure dogs in addition to usual care, with usual care alone. The study includes adults with epilepsy for whom current treatment options failed to achieve seizure freedom. Seizure frequency of participants should be at least two seizures per week, and the seizures should be associated with a high risk of injury or dysfunction. During the 3 year follow-up period, participants receive a seizure dog in a randomized order. Outcome measures are taken at multiple time points both before and after receiving the seizure dog. Seizure frequency is the primary outcome of the study and will be recorded continuously using a seizure diary. Questionnaires measuring seizure severity, quality of life, well-being, resource use, productivity, social participation, and caregiver burden will be completed at baseline and every 3 months thereafter. The study is designed to include a minimum of 25 participants.
Discussion: This protocol describes the first randomized controlled trial on seizure dogs. The study will provide comprehensive data on the effectiveness and cost-effectiveness of seizure dogs in adults with medically refractory epilepsy. Broader benefits of seizure dogs for persons with epilepsy and their caregivers are taken into account, as well as the welfare of the dogs. The findings of the study can be used to inform decision-makers on the reimbursement of seizure dogs.
We have previously reported that dogs can be trained to recognize specific changes preceding an epileptic seizure in humans. Such dogs can provide an overt signal that acts as a useful warning to the human. Early observations suggested that seizure frequency might also be reduced. We report a prospective study of 10 consecutive referrals to our Seizure Alert Dogs ®service of people with tonic–clonic seizures. Seizure frequency was monitored over a 48 week period including 12 weeks baseline after entry, a 12 week training period, and 24 weeks follow up. Comparing baseline seizure frequency to the last 12 weeks of follow up, there was a 43% mean reduction in seizure frequency ( P= 0.002). Nine out of /10 subjects showed a 34% or greater reduction, 4 /10 showed a 50% or greater reduction, and only one showed no improvement. Although a significant drop in seizure frequency was seen during the first 4 weeks of training ( P= 0.0078) a further drop occurred between the first and last 4 week period of training (P = 0.038) and this final improvement was maintained for the whole 24 week follow up.
Anecdotal evidence suggests that some dogs may be able to sense the onset of seizures and other medical conditions in humans, although this has never been explored scientifically. There is, however, evidence that dogs can be specially trained to recognize specific changes preceding a seizure and give an overt signal enabling the dog to warn his/her owner. The introduction of the use of dogs to detect and accurately predict the onset of a seizure, giving sufficient time for a person to take control of the situation will have a dramatic impact on quality of life. Support Dogs, a registered charity which trains dogs to assist disabled people, has successfully trained several ‘Seizure-alert dogs’. As training progressed, the dogs were able to provide overt signals to their owners within time periods varying from 15 to 45 minutes prior to a seizure occurring. Each dog had an accurate prediction time and, in each case, the owner’s seizure frequency was reduced.
Aims
Domestic dogs are trained to a wide variety of roles including an increasing number of medical assistance tasks. Glycaemia alert dogs are reported to greatly improve the quality of life of owners living with Type 1 diabetes. Research into their value is currently sparse, on small numbers of dogs and provides conflicting results. In this study we assess the reliability of a large number of trained glycaemic alert dogs at responding to hypo- and hyper-glycaemic (referred to as out-of-range, OOR) episodes, and explore factors associated with variations in their performance.
Methods
Routine owner records were used to assess the sensitivity and specificity of each of 27 dogs, trained by a single UK charity during almost 4000 out-of-range episodes. Sensitivity and positive predictive values are compared to demographic factors and instructors’ ratings of the dog, owner and partnership.
Results
Dogs varied in their performance, with median sensitivity to out-of-range episodes at 70% (25th percentile = 50, 75th percentile = 95). To hypoglycaemic episodes the median sensitivity was 83% (66–94%) while to hyperglyaemic episodes it was 67% (17–91%). The median positive predictive value (PPV) was 81% (68–94%), i.e. on average 81% of alerts occurred when glucose levels were out of target range. For four dogs, PPV was 100%. Individual characteristics of the dog, the partnership and the household were significantly associated with performance (e.g., whether the dog was previously a pet, when it was trained, whether its partner was an adult or child).
Conclusions
The large sample shows that the individual performance of dogs is variable, but overall their sensitivity and specificity to OOR episodes are better than previous studies suggest. Results show that optimal performance of glycaemic alert dogs depends not only on good initial and ongoing training, but also careful selection of dogs for the conditions in which they will be working.
Previous studies have suggested that some pet dogs respond to their owners’ hypoglycaemic state. Here, we show that trained glycaemia alert dogs placed with clients living with diabetes afford significant improvements to owner well-being. We investigated whether trained dogs reliably respond to their owners’ hypoglycaemic state, and whether owners experience facilitated tightened glycaemic control, and wider psychosocial benefits. Since obtaining their dog, all seventeen clients studied reported positive effects including reduced paramedic call outs, decreased unconscious episodes and improved independence. Owner-recorded data showed that dogs alerted their owners, with significant, though variable, accuracy at times of low and high blood sugar. Eight out of the ten dogs (for which owners provided adequate records) responded consistently more often when their owner’s blood sugars were reported to be outside, than within, target range. Comparison of nine clients’ routine records showed significant overall change after obtaining their dogs, with seven clients recording a significantly higher proportion of routine tests within target range after obtaining a dog. HbA1C showed a small, non significant reduction after dog allocation. Based on owner-reported data we have shown, for the first time, that trained detection dogs perform above chance level. This study points to the potential value of alert dogs, for increasing glycaemic control, client independence and consequent quality of life and even reducing the costs of long-term health care.
Standard classification of canine vocalisations is severely limited for assistance dogs, where sample data is sparse and variable across dogs and where capture of the full range of bark types is ethically constrained. We reframe this problem as a continuous regression task within a two-dimensional arousal-valence space. Central to our approach is an adjusted Siamese Network trained not on binary similarity, but on the ordinal and numeric distance between input sample pairs. Trained on a public dataset, our model reduces Turn-around Percentage by up to 50% on the challenging valence dimension compared to a regression baseline. Qualitative validation on a real-world dataset confirms the learned space is semantically meaningful, establishing a proof-of-concept for analysing canine barking under severe data limitations.
Objectives: The Epilepsy Support Dog Evaluation study was commissioned by the Dutch Ministry of Health, Welfare and Sports to inform a reimbursement decision on seizure dogs. The randomized trial found that seizure dogs reduce seizure frequency and improve health-related quality of life of persons with severe refractory epilepsy (PSREs). This article examined the cost-effectiveness (CE) of adding seizure dogs to usual care for PSREs in The Netherlands.
Methods: A microsimulation model was developed, informed by generalized linear mixed models using patient-level trial data from the Epilepsy Support Dog Evaluation study. The model adopted a 10-year time horizon and took a societal perspective. Seizure frequency was predicted as a function of time with the seizure dog. Patient utilities, caregiver utilities, and costs were predicted as a function of seizure frequency and time with the seizure dog.
Results: Quality-adjusted life-years (QALYs) of PSREs with a seizure dog and usual care alone were estimated at 6.28 and 5.65, respectively (Δ 0.63). For caregivers, estimated QALYs were 6.94 and 6.52, respectively (Δ 0.42). Total costs were respectively €228 691 and €226 261 (Δ €2430). Intervention costs were largely offset by savings in informal care and healthcare. The incremental CE ratio was €2314/QALY. Probabilistic sensitivity analysis indicated a 91% probability of seizure dogs being cost-effective at the €50 000/QALY threshold. The incremental CE ratio fell well below this threshold in scenario analyses.
