Effect of comorbidities on medical care use and cost among refractory patients with partial seizure disorder.
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.
Lee
Won Chan
WC
HERQuLES, Abt Associates Inc., 4800 Montgomery Lane, Suite 600, Bethesda, MD, USA. WonChan_Lee@abtassoc.com
Arcona
Steve
S
Thomas
Simu K
SK
Wang
Qin
Q
Hoffmann
Marc S
MS
Pashos
Chris L
CL
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
D000927:Anticonvulsants