Burden of uncontrolled epilepsy in patients requiring an emergency room visit or hospitalization.
OBJECTIVE
To quantify the clinical and economic burden of uncontrolled epilepsy in patients requiring emergency department (ED) visit or hospitalization.


METHODS
Health insurance claims from a 5-state Medicaid database (1997Q1-2009Q2) and 55 self-insured US companies ("employer," 1999Q1 and 2008Q4) were analyzed. Adult patients with epilepsy receiving antiepileptic drugs (AED) were selected. Using a retrospective matched-cohort design, patients were categorized into cohorts of "uncontrolled" (≥ 2 changes in AED therapy, then ≥ 1 epilepsy-related ED visit/hospitalization within 1 year) and "well-controlled" (no AED change, no epilepsy-related ED visit/hospitalization) epilepsy. Matched cohorts were compared for health care resource utilization and costs using multivariate conditional regression models and nonparametric methods.


RESULTS
From 110,312 (Medicaid) and 36,529 (employer) eligible patients, 3,454 and 602 with uncontrolled epilepsy were matched 1:1 to patients with well-controlled epilepsy, respectively. In both populations, uncontrolled epilepsy cohorts presented about 2 times more fractures and head injuries (all p values < 0.0001) and higher health care resource utilization (ranges of adjusted incidence rate ratios [IRRs] [all-cause utilization]: AEDs = 1.8-1.9, non-AEDs = 1.3-1.5, hospitalizations = 5.4-6.7, length of hospital stays = 7.3-7.7, ED visits = 3.7-5.0, outpatient visits = 1.4-1.7, neurologist visits = 2.3-3.1; all p values < 0.0001) than well-controlled groups. Total direct health care costs were higher in patients with uncontrolled epilepsy (adjusted cost difference [95% confidence interval (CI)] Medicaid = $12,258 [$10,482-$14,083]; employer = $14,582 [$12,019-$17,097]) vs well-controlled patients. Privately insured employees with uncontrolled epilepsy lost 2.5 times more work days, with associated indirect costs of $2,857 (95% CI $1,042-$4,581).


CONCLUSIONS
Uncontrolled epilepsy in patients requiring ED visit or hospitalization was associated with significantly greater health care resource utilization and increased direct and indirect costs compared to well-controlled epilepsy in both publicly and privately insured settings.
GlaxoSmithKline, Research Triangle Park, NC, USA. ranjani.y.manjunath@gsk.com
Ranjani
R
Manjunath
Pierre Emmanuel
PE
Paradis
Hélène
H
Parisé
Marie-Hélène
MH
Lafeuille
Brian
B
Bowers
Mei Sheng
MS
Duh
Patrick
P
Lefebvre
Edward
E
Faught
D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid / Q000191:economics; D008875:Middle Aged; D009017:Morbidity; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
D000927:Anticonvulsants