title: Costs, work absence, and adherence in patients with partial onset seizures prescribed gabapentin or pregabalin.
abstract: OBJECTIVE
  Few studies have examined cost of illness of epileptic partial onset seizures (POS) from the employer perspective or compared users of gabapentin and pregabalin in treatment of POS. This study compares pharmacotherapy, direct/indirect costs, and work absences of patients with POS newly started on gabapentin or pregabalin.
  
  
  METHODS
  Data from employees and dependent spouses with POS starting treatment (index date) with either gabapentin or pregabalin were analyzed. Patients were required to have at least 6 months of health plan enrollment pre- and post-index. Regression modeling compared medical and prescription costs, sick leave (SL), short-term disability (STD), workers' compensation (WC) costs and absence days during the 6-month post-index period. Persistence, adherence (proportion of days covered), impact on adherence of copay, and copay as a percent of salary were modeled.
  
  
  RESULTS
  Semiannual medical, drug, SL, STD, and WC costs for gabapentin vs. pregabalin cohorts were $10,306 vs. $9186, $2353 vs. $3387 (P=0.01), $552 vs. $342, $1280 vs. $580, and $170 vs. $30, respectively. SL days (10.8 vs. 1.5, P=0.04) and STD days (9.8 vs. 6.2) were lower in the pregabalin cohort. Persistence (median 94 vs. 70 days) and proportion with ≥ 80% adherence (30% vs. 15%, P=0.049) were greater in the pregabalin cohort. Adherence decreased as copay or copay as a percent of salary increased beyond specific levels in both cohorts.
  
  
  CONCLUSIONS
  Despite higher acquisition costs for branded pregabalin over generic gabapentin, overall direct and indirect costs trended lower for pregabalin users. Additionally, pregabalin users had significantly fewer sick leave days and significantly higher adherence rates than gabapentin users.
authors.affiliation: HCMS Group, 1800 Carey Ave, Suite 500, Cheyenne, WY 82001, USA. nathan_kleinman@hcmsgroup.com
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Kleinman
authors.forename: Alesia
authors.initials: A
authors.lastname: Sadosky
authors.forename: Jaren
authors.initials: J
authors.lastname: Seid
authors.forename: Roy C
authors.initials: RC
authors.lastname: Martin
authors.forename: David M
authors.initials: DM
authors.lastname: Labiner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000588:Amines / Q000191:economics / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D003509:Cyclohexanecarboxylic Acids / Q000191:economics / Q000627:therapeutic use*; D016208:Databases, Factual / Q000706:statistics & numerical data; D016527:Drug Costs / Q000706:statistics & numerical data; D004828:Epilepsies, Partial / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D005260:Female; D000077206:Gabapentin; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D000069583:Pregabalin; D018582:Sick Leave / Q000191:economics / Q000706:statistics & numerical data*; D014942:Workers' Compensation / Q000191:economics / Q000706:statistics & numerical data; D055815:Young Adult; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
chemical_list: D000588:Amines; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin