title: Effect of comorbidities on medical care use and cost among refractory patients with partial seizure disorder.
abstract: OBJECTIVE
  The goal of this work was to assess the effect of comorbidities on medical care use and costs among patients with partial seizure disorder who are also refractory to initial antiepileptic drug (AED) monotherapy.
  
  
  METHODS
  Retrospective data from the PharMetrics managed care claims database were collected for adult patients treated with AED monotherapy between January 1, 2000 and March 31, 2002. The associations of comorbidity, specifically the Charlson Comorbidity Index (CCI) and incidence of specific comorbid conditions, with total costs and with hospitalization were analyzed via econometric analysis and logistic regression.
  
  
  RESULTS
  Five hundred forty-nine patients were identified and analyzed. The odds of hospitalization were 3.7 times greater among patients with a CCI1, than for patients without comorbidities (OR=3.7, 95% CI=1.7-7.9), while treatment costs for all medical care were 136% higher (P<0.05). Depression had the largest marginal effect on costs and on the likelihood of hospitalization.
  
  
  CONCLUSIONS
  For patients refractory to initial AED monotherapy, the presence of comorbidities, especially depression, is associated with a substantial increase in medical care use and costs.
authors.affiliation: HERQuLES, Abt Associates Inc., 4800 Montgomery Lane, Suite 600, Bethesda, MD, USA. WonChan_Lee@abtassoc.com
authors.forename: Won Chan
authors.initials: WC
authors.lastname: Lee
authors.forename: Steve
authors.initials: S
authors.lastname: Arcona
authors.forename: Simu K
authors.initials: SK
authors.lastname: Thomas
authors.forename: Qin
authors.initials: Q
authors.lastname: Wang
authors.forename: Marc S
authors.initials: MS
authors.lastname: Hoffmann
authors.forename: Chris L
authors.initials: CL
authors.lastname: Pashos
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000927:Anticonvulsants / Q000191:economics* / Q000627:therapeutic use; D015897:Comorbidity; D003866:Depressive Disorder / Q000191:economics / Q000453:epidemiology; D004828:Epilepsies, Partial / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology*; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors
chemical_list: D000927:Anticonvulsants