OBJECTIVES: To quantify annual drug costs and hospitalization rates (HR) of adult refractory focal epilepsy patients in Germany. METHODS: We retrospectively estimated the annual HR and medication for refractory focal epilepsy patients based on the NeuroTransData epilepsy database (input from 79neurologists, 34centers, 1240patients). Inclusion criteria (at least 1year of disease history; documentation and treatment period of at least 6months; treatment with at least 1anitepileptic drug [AED] in patient history; at least 1seizure during 6months of monitoring) led to the identification of 70 patients. Average ambulatory daily therapy costs among all prescribed drugs included were based on public prices (2011) considering clawbacks and average dosing (real world setting [RWS] vs. daily defined dosing [DDD]). HR were based on number of patients hospitalized. RESULTS: On average 2.1AEDs per patient were prescribed, mainly generic drugs or branded drugs close to loss of patent protection. Average daily costs per prescribed drug ranged from 0.65€ (Valproate) to 9.51€ (Lacosamid). Daily drug costs per patient ranged between 7.01€ (RWS) and 6.16€ (DDD). Annual total drug costs per patient were on average 2,557.44€. An ambulatory consultation rate of 2.1visits per patient within 6months was recorded. Average HR was 44%, taking into account various reasons: 56% emergency, 20% new adjustment for medication, 18% documentation of seizure, 4% rehabilitation, 2% pre-surgical diagnostics. Mean duration was 34.9 (CI: 20.2-49.6; median 17.8) days per patient hospitalized. Due to the potential selection bias and the low number of analysed patients these results must be seen as indicative. CONCLUSIONS: A 44% HR and a high average number of inpatient days (~1month) within 1year point to an unmet need for treatment optimization in refractory focal epilepsy patients. It indicates that patients receiving combination therapy of conventional drugs are often not well controlled, supporting the consideration of using more innovative drugs.